What makes someone an expert?

The world seems to be filled with experts – as to whether an expert is the same as the old-fashioned term ‘master’ I am not sure.

I remember by grandfather explaining mastery to me many years ago. The story goes that he started-out, sometime in 1920s Newcastle as an apprentice cabinet maker, after a period of time when his apprenticeship had been served he became a journeyman and ultimately a master craftsman.

I never asked how the ‘master’ title was conferred – was this a numbers thing i.e. after 10 years or a hundred dovetailed cabinets as journeyman you automatically become a master. Is it when you join a certain society?

I often see vans driving about Doncaster with ‘Society of Master Craftsmen’ on the side. I assume this means that the builder has passed a test or a rite of passage to be allowed to use this sign, the assumption being that if a Master builds a house for you it is less likely to fall-down that if an amateur does so.

I suspect this is along the lines of the Royal College of which I am a fellow – I don’t want to give too much away or erode peoples’ confidence in my clinical abilities, but, the process for becoming a fellow was solely dependent upon my being a member for five years (sure you need to pass a few quite tricky exams to become a member, but that is all) and one of the already fellows supporting my ‘election’; oh, that an a few hundred pounds each year for membership (or fellowership).

There is perhaps more to being a fellow than this, although I am not certain – likely, if I did something very wrong, perhaps brought the society into disrepute, my fellowership might be revoked, although as I don’t tend to talk about this beyond the confines of this blog, I doubt it would make a massive difference to my life overall.

The point being, if someone calls themselves FRCP or FRCA or FRSA or whatever, it sort of suggests they know something beyond which an everyday person might. I learned yesterday about someone who is an FRCP as well as a master ballroom dancer – this suggesting that they have mastery in two different fields.

I suppose one of the worries I have about people saying they are an expert or possess expertise or mastery in a certain area is that is makes people believe that what they are saying is more likely to be true than someone else.

Taking an example from my own recent, experience, having gone to the opticians (for the first time in my life), discovering that not only do I have an astygmatism, I am also a little short-sighted.

I have been wearing specs for the past couple of weeks and can’t work-out whether I have problems with my vision or not, or whether the specs that I am currently wearing are actually damaging my eyesight (which I feel is the case), although, because an expert optician has told me about my visual frailty, it is surely not so (he had diplomas on the wall of his office).

I am left with specs, which, a few people have told me make me look ‘intelligent’ so, I’ll probably keep them. Is it possible that my wearing the specs will make me look more like an expert?

Do the patients think to themselves, ‘Here comes the doctor with the specs – he must know what he is talking about,’ or is it what I have believed up until now, that the patients are more moved by what and how I communicate rather than what I look like. (It would be interesting for me to dress-up – perhaps with a coifed wig, natty clothes, tattoos and no specs and see if they react differently.)

I fear I am getting a off the point!

I am trying to work-out what makes an expert. And, for that matter, whether I am an expert – in anything;

And even, if being an expert makes any difference;

We talk these days about ‘patients as expert’ (sometimes called, expert by experience) – indeed, there is a recent blog by Cormac Russell exploring this here.

If I have, say, multiple sclerosis – who is the expert? Well, the professor might be an ‘expert’ in MS, they might even know more about my MS than anyone else after having been my doctor for years, yet, I am the expert in my MS – it is my disease, I live with it every day of the week – I understand the frustrations, the limitations, the pains; the depth of understanding which I possess is incomparable to that of even the most learned academic.

I guess this complicates matters – as when we hear that someone is an expert we assume that they know more than average, or more about something than is common knowledge, but, what is common knowledge, as, surely that must vary between people, communities and time?

If I show my iPhone to someone who has never seen a mobile before, they will assume (once they have overcome my apparent godliness), that I am an expert in iPhones – my ability to navigate the apps and the settings, for example, being a reflection of this. Yet, should that person hang-around in 21st century Westernised society for a while and meet an Apple Genius* – they will soon realise that my luddite fumbling was far from expert.

*Or any Millennial for that matter.

So expertise and mastery are relative terms that probably change over time and context.

I suppose what all this is leading to is the suggestion that whenever we hear that someone is an expert, whether they say so themselves, or others about them, we shouldn’t just assume all is well; a healthy questioning approach to all things is surely better than passive acceptance.

I’ll end with an anecdote I sometimes use when talking about polypharmacy.

A few years ago I went to my GP as my perennial rhinitis was getting me down. The usual treatments – nose sprays and over-the-counter anti-histamines weren’t working and I was fed-up. The GP suggested I try a new drug – a ‘non-drowsy’ anti-histamine.

I willingly took the medicine and started popping the pills.

It was only a couple of weeks later when I started feeling very tired, particularly when I was travelling home from work – to the extent that I had to pull into a lay by most nights for a nap that I realised something was wrong. I assumed I was working too hard, perhaps an under-active thyroid, or some more sinister malady.

Ultimately it transpired that the non-sedative antihistamine’s main side-effect was sedation, and, my faith in the expert guidance of the GP had led me to lower my guard, assume that of all things, it couldn’t be that which was causing my malaise.

Questioning authority is becoming more of an accepted norm within society which I applaud; let us keep challenging and questioning the accepted logic, the obvious or the expected, until we arrive at a point where ‘expert’ suggests expertise in asking questions and being open.

Rod Kersh, FRCP

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2 thoughts on “I am an expert…

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