Years ago, Dr. A., a charming, well-versed family practitioner with several decades of clinical experience, was lecturing our medical school class about certain maladies he had encountered in clinical practice. A mysterious rash. An unnerving breathlessness. Feet that would burn. Hiccups that would not go away. You name it—he saw it. Not only were these talks fascinating, but they were refreshing in that they offered us gulps of deliciously fresh air as we emerged (for an hour) from the deep, punishing plunges in biochemistry, histology, and pathology.
At one point in the discussion, one of the braver students raised a question about the uncertainty inherent in Dr. A.’s work. How, it was asked, do you deal with stubborn probabilities in situations that seem to demand absolute certainty? How do you keep perspective? The aging doctor cracked a smile. “In medicine, you will always deal with probabilities and uncertainties—and you will gain a wider, edifying perspective—unless you opt to become a left earlobe doctor at the Cleveland Clinic.”
Now, to be fair, I have a few friends who work at the Cleveland Clinic (outstanding specialists and generalists, all). But I have never met a left earlobe doc. I’m pretty sure the specialty doesn’t exist. Instead, it seems Dr. A’s tongue was firmly planted in cheek to illustrate the perspective that can be lost by the “hyper-specialist.” Now, to be sure, we know that even when you narrow down from experience that is “a mile wide and an inch deep” to that which is “an inch wide and a mile deep,” you still don’t arrive at infallible certainty. Whatever your expertise, there is always a water’s edge where you leave off from certainty and stare into the realm of the unknown. Dr. A.’s larger point, rather, is that you shouldn’t have a left earlobe doctor mindset. As you develop expertise, don’t lose track of the big picture. In coping with uncertainty, it is important not only to have a deep fund of knowledge but also a wide breadth of experience that offers you context and proportionality, insight and wisdom, humility and alertness to navigate the uncertain paths of life.
The scientific revolution through which we have all lived has brought us miracles of specialization. Just consider the wonder of chemotherapies and electric cars, refrigerators and space shuttles, iPhones and indoor plumbing. And in the field of medicine, we have seen specialization in an almost unparalleled fashion. It is nothing short of miraculous to see one pound “preemies” flourish, widowmaker heart attacks stented, failing kidneys relieved by transplant, and horrible burn victims meticulously grafted. A heart malady that was once the purview of the general practitioner is now in the wheelhouse of the cardiac electrophysiologist. Specialization has begotten expertise and expertise has begotten specialization. And all of this seems to be for the good.
The problem, however, is when our drive to forever specialize stunts the perspectives of the specialist (Dr. A.’s left earlobe doctor who develops tunnel vision) or the generalist (the family practitioner who despairs and all but gives up on ever truly grasping “expert knowledge”). The risk in a specialized world is that we all become reduced to being mere technicians. When I say technician, I am referring to someone who focuses on their one thing and their one thing alone. They have no interest in how their work contributes to the whole. They lose track of their work’s proportion. They care little about the ramifications of their area of concern for all the other parts to which their work is linked. This technician’s work becomes walled-in, cramped, intoxicated with niggling utility and pedantic technique at the expense of understanding “the bigger picture.” As human beings, no matter how isolated our work may be, we must think about how our work fits—our work’s context—to understand how and why it truly matters. Even the most isolated among us live and die as part of some community. As complex as our lives are, we can’t get by if we simply “stick to our knitting.” The nephrologist cannot care only for the patient’s kidneys; she must also pay obeisance to her patient’s heart problem, Parkinson’s disease, and inability to afford expensive medications. The quarterback cannot care for his receivers and running back alone; he must be invested in the strength of the line, the success of the defense, and the wisdom of the coaching staff.
Now, to be sure, all of our efforts to think broadly must be accompanied by a discipline to think better. Physicist Richard Feynman warned, “The first principle is that you must not fool yourself and you are the easiest person to fool.” Information alone does not guarantee insight. There are many well-read numbskulls out there. T.S. Eliot once asked, “Where is the wisdom we have lost in knowledge? Where is the knowledge we have lost in information?” When mentoring my medical students and residents, I remind them that smart doctors are a dime-a-dozen. Mastery of facts is commonplace. But a wise doctor? Now that’s where the magic is. We must cultivate wits to purify our facts. By broadening our understanding, we are honing our judgment. By honing our judgment, we are achieving wisdom that will (God-willing) enable us to live a good and discerning life.
Make no mistake—expertise is good. In fact, it is indispensable. But so is a broader perspective that chastens our narrow view, humbles our infallible assertions, and warms us to the rest of the story.
As I reflect back on Dr. A’s quip, it is hard not to smile. I don’t think he really had a problem with left earlobe doctors.
He just didn’t want us to think like one.