The redefinition of “expert” is at ethical, mortal, and public necessity. The current COVID era has taught us that the self-publishing online, talk-radio, and home-grown podcasts and YouTube channels, as well as self-started Newscasts, have completely confounded legitimization of actual intellectual-ethical sources. Recently my conversation with a friend discovered how this intelligent layman was lead astray in a simple matter: a rage daddy-blog published a thought, it was tweeted then reblogged, then picked up by a big-name conservative talking head which then made its way to the pulpit when his pastor quoted the misinformation. He fully admitted when I checked the source in front of him that he hadn’t thought twice as it was “everywhere he looked” and thus assumed true. In our information age, more important now than ever, we have to ensure we and our patients, friends, family, neighbors, and countrymen are getting accurate and true information.
This week the CDC announced that the PCR test for COVID would have its EUA (Emergency Use Authorization) end on December 31st, 2021.[i] Immediately the misinformation was put out: “The COVID PCR test is falsely high as it counts Flu as COVID!!!” This is simply not the case and while I do see the maliciousness of the fake news movement, those that are closest to me simply do not understand the “big words” within the CDC announcement to fully understand the direction of advice given by one of our expert standard-bearers. To address this in short, the PCR as the “gold standard” is being reduced and re-recommended: it only tests for a nucleic acid found only in COVID. This means it is an extremely narrow and specific test and is not susceptible to influenza false positives due to this specificity. However, at the beginning of the COVID battle, it was the ONLY test we had. Since then, multiple other tests have been created which are almost as accurate, yet faster, and can test for multiple conditions upfront. The CDC addresses this in a multiplexed leveling: “Such assays can facilitate continued testing for both influenza and SARS-CoV-2 and can save both time and resources as we head into the influenza season.” Noted, the announcement hopes that COVID-19, the flu, and variants of each can be discovered in one test with our current knowledge. This is a science and medical practice win for best care, yet a failure of our shared understanding of the information among laymen and their understanding of science and medicine (I’m purposefully discounting the influence of talking head here). Thank goodness additional –laymen friendly- fact checks can easily be sourced.[ii]
What are we to do? You are the expert dear practitioner! (and some of you double-guessed yourself in that statement) My laymen friends do not have years of undergraduate math and science, the countless hours of medical school examination, the hours of extern/intern/residency, nor the HOURS I spent researching my thesis for my fellowship and defending it to my peers. I know I am not a virologist, epidemiologist, or even a public health nurse…. But I have the “best” understanding of those subjects compared to my friend group and know obvious falsehoods when I see them. While I do not FEEL like a true expert, I am in comparison to my relations.
Secondly, I need to trust others who are, indeed, experts though the credentials may not be as high-brow as I feel they need to be. By that I mean, recognizing our healthcare partners that typically fall under the titles of ancillary care or secondary care—public health nurses, Nurse Practitioners, and Physicians’ Assistants (Associates based on the new terminology). With the current COVID situation in my area, the true expert is our PA. I accepted his advice due to his immersion in COVID testing and contact tracing over the months. Only afterward did I see a diploma on his wall, “Ph.D., Epidemiology.” Talk about a bit of a humbling internal dialogue. I, at times, thought “he’s just a PA, but knows what he is talking about.” We have to beware of the professional downplaying of our colleagues!
I found two definitions I’d like to think about in the way of experts. First, in the way of the book “Blink” by Malcolm Gladwell, (my paraphrase): An expert has years of study and experience in that his/her craft comes naturally, as an almost gut feeling. With a simple glance- a blink- an expert can deduct a falsehood or truth. It is such fast processing of information within an intellectually-trained-reflex, it often takes longer to explain the “why” than whether the information is false/true.[iii]
Furthermore, the text “How People Learn: Brain, Mind, Experience, and School” lists a series of considerations for how experts differ from Novices:
“We consider several key principles of experts’ knowledge and their potential implications for learning and instruction:
- Experts notice features and meaningful patterns of information that are not noticed by novices.
- Experts have acquired a great deal of content knowledge that is organized in ways that reflect a deep understanding of their subject matter.
- Experts’ knowledge cannot be reduced to sets of isolated facts or propositions but, instead, reflects contexts of applicability: that is, the knowledge is “conditionalized” on a set of circumstances.
- Experts are able to flexibly retrieve important aspects of their knowledge with little attentional effort.
- Though experts know their disciplines thoroughly, this does not guarantee that they are able to teach others.
- Experts have varying levels of flexibility in their approach to new situations.”[iv]
In short, my paraphrase: “I cannot explain this topic because it would take hours of back-study to understand the basic conceptual intricacies to begin the discussion, let alone argue pros/cons about it.”
For the practiced mind, we typically level ourselves realistically against our own perceived “expertise” and biases. Remember- you are more an expert as a medical practitioner than a layman, but less so than a specialty in that field. YET, you are aware of this fact and know WHERE to get proper information for discourse (or diagnosis as it were) compared to the general public. I rate and rank myself to ensure I am honest with myself and ensure I have the best information or the best opinion from an expert as their opinion outweighs mine in their specialty.
In the end, we must push back the untruth that experts “do not know” as the public and fake news often state, simply because an opinion changed. Even with the opinion explained the depth of knowledge required for the general-educated public to comprehend is lacking. Unfortunately, this then feels like a falsehood to them.
Imagine with me: what if the talking heads had an ethical, moral, and legal duty to ensure best care was given to a patient and had professional licensure among years of invested study at risk if malicious information was given?
Maybe one day?
Final thought: challenge, in a friendly way, these conceptions with your patient: “Interesting thought, but not anything that I’d put stock into. Did you read that in a medical journal? Did a doctor say that? No, it was on a political opinion show? Is that news anchor a doctor?”
It is a small battle, but in my trusted circles simply asking how their “expert” gives information refocuses things to a realistic level: “Were you mad/angry afterward? Ah, that’s how you know you were being sold. Rage sells.”
Let us reclaim our space, and stand securely together as learned, professional experts.
[i] https://www.cdc.gov/csels/dls/locs/2021/07-21-2021-lab-alert-Changes_CDC_RT-PCR_SARS-CoV-2_Testing_1.html
[ii] https://www.politifact.com/factchecks/2021/jul/30/facebook-posts/cdc-test-cant-differentiate-between-covid-and-flu-/
[iii] Gladwell, Malcolm. “Blink: The power of thinking without thinking.” (2006).
[iv] https://www.nap.edu/read/9853/chapter/5
Author – Larry Plaxco
Editor – Blake Busey DO, Revolutionary Healthcare PLLC
Revolutionary Healthcare PLLC 