Expertise Can Wear Many Faces

Modern healthcare could not survive without experts and their years of experience and training, but when expertise becomes dogmatic, innovation is slowed. We need to be more inclusive in our definition of expertise.

By John Halamka, M.D., President, Mayo Clinic Platform, and Paul Cerrato, senior research analyst and communications specialist, Mayo Clinic Platform.

As most clinicians know, expertise is an indispensable part of medical practice. As we point out in our new book, Redefining the Boundaries of Medicine, without experts, patients would be left to navigate complex healthcare issues on their own; and countless government officials and business executives would be deprived of much-needed intelligence to make day-to-day decisions. By on the other hand, experts must have humility and a willingness to accept new ideas. As Richard Feynman, the Nobel prize-winning physicist, once said: “In order to progress, we must recognize our ignorance and leave room for doubt…” Thomas Huxley, the 19th-century British biologist, took that observation a step further, pointing out that new truths in science “often begin as heresy, advance to orthodoxy, and end as superstition.” We must learn to explore new ideas, fund new experiments outside of mainstream orthodoxy, and disrupt our own business models in the interest of finding a better way.

If health care is to move beyond the status quo, it will have to embrace a community of thinkers including patients, citizen scientists and independent scholars. We must embrace unconventional thinkers who can “color outside the lines” and generate innovations that move medicine into the future. Because experts also serve as gatekeepers and peer reviewers for the most influential medical journals, they must embrace a tolerance for novel inquiry.

BMJ Health and Care Informatics (BMJ HCI) recently launched a program that brings patients, the general public, and caregivers into the loop, enabling them to serve as both authors and peer reviewers. The new program will give those outside traditional academic circles a voice. As Dana Lewis and Philip Scott state in BMJ HCI: “There are many benefits to having patient reviewers, such as providing clarity to the authors by asking more detailed questions about design, methods and analyses. Patient reviewers can provide insight into the language of a manuscript that can be unintentionally written in a jargon-filled way that may not be understandable to patients or other researchers.” Similarly, the opportunity to write for the professional medical press will enable readers to be exposed to “perspectives that are not currently found in existing medical literature…[and] improve the understanding of the lived experience of the disease or condition, including interactions and communication with the healthcare system.”