In my musings about the current state of wound care practice, I have pondered the honored custom of identifying leaders in wound care as "experts."
The term expert denotes a certain level of an individual's status, knowledge, reputation, prestige, education, certification, professional achievement, and peer recognition. In my opinion, use of the "expert" label is advancing ubiquitously in our field, and some worry that this is akin to inflation. An explanation might lie, however, in the general advancement of knowledge in the wound care field, the prominence of professional wound care organizations and their credentialing and certification initiatives, and, of course, self-elaboration.
Use of the "expert" moniker is commonplace, especially in our general taxonomy of discourse in the field, peer introductions, oral presentations, discussions, clinical consensus panels, peer-review processes, manuscripts, and consultations. The term has a particular omnipotent status in the courts, when an "expert witness" takes the stand in medical liability cases about chronic wound management.
The Expert and Beyond
We may now have more experts in the wound care field than ever. Thus, how does one carefully examine the phenomena of expertism? Surely, a thorough examination of this subject will make some of us move out of our expert comfort zone, but hopefully, at the same time, it will enhance our understanding about expertism. With this in mind, I set out to find some logical methodology or thought process by which we could explore the origin of the illustrious title of expert in health care.
Defining Expertism
According to Merriam-Webster's Dictionary, an expert (noun) is a person who has special skill or knowledge in a particular subject, such as a science or art, whether acquired by experience or study. An expert can also be conceptualized nowadays as an "expert system," that is, a computer program that follows a logical pathway or algorithm to a conclusion in the same manner an expert in the field would follow.
In a legal sense, expert testimony is the sworn statements of a person with specialized knowledge about a subject that is under review by a court of law. This person is known as an expert witness.
Experts Among Experts
Philip Tetlock, an expert in expertism, concludes that the accuracy of an expert's predictions actually has an inverse relationship to his or her self-confidence, renown, and, beyond a certain point, depth of knowledge. He further states, "In this age of academic hyperspecialization, there is no reason for supposing that contributors to top journals-distinguished political scientists, area study specialists, economists, and so on-are any better than journalists or attentive readers of The New York Times in 'reading' emerging situations." He also believes that experts are more overconfident than their colleagues who eked out existences far from the limelight, and experts used a double standard: they were much tougher in assessing the validity of information that undercut their theory than they were in crediting information that supported their own theories. Similarly, the behavior of authors and peer reviewers frequently validate this hypothesis.
The Expert Witness
A diversity of opinion exists regarding the definition of an expert witness. Moreover, debate continues on how the exact expertise of a given individual is established and the professionalism that is expected from him or her. As with most professional activities, the parameters for expected professional behaviors are not an exact science. Currently, there are no credentialing standards that govern the practice of professional witness. Some states and professional organizations, however, are beginning to establish guidelines by closely examining the issue. The American Academy of Pediatrics and the American Medical Association, for example, have identified several important facets of this complex issue. They include prevention, peer review, and the potential for sanctioning if the expert does not conform to accepted practices. Moreover, a move is afoot in several state jurisdictions to preclude the "professional expert witness" from participating in a freelance hired gun behavior.
Ideally, the expert witness should hold a valid license in the state in which he or she will be providing testimony, be board certified, participate in direct patient care, and cap his or her fees in line with other professional services rendered by the specific medical practice he or she practices. In some sectors, the selection process of expert witnesses is being examined-should they be appointed by peers, the courts, or specialty societies? In addition, consideration should be given as to whether expert witness activities are considered the practice of health care, and should they be subject to peer review with liability for their testimony?
Certainty or Uncertainty
From a philosophical perspective according to Plato, knowledge is a subset of that which is both true and believed (subjective and objective). Therefore, one can conclude that experts also have belief systems as part of their knowledge portfolio. To carry this thought further, their expert opinions are part fact, belief, experiences, and inherent biases. Visualize 2 wound care experts debating an issue-both are certain about their respective positions. Yet given the above discussion, we are likely to come away from listening to such a debate with more uncertainty than certainty. In fact, it is a well-known research axiom that all hypotheses to be valid must begin with uncertainties that will logically terminate with certainties.
As I examine my feelings about my own expertise, I can only say that I wish I knew today what I thought I knew a decade ago. Given that self-observation, I aspire to a more humble status, probably a notch below the exalted expert. In fact, I like to use the term "thought and content leader" as an alternative descriptor. That encompasses many of us who speak and write about wound care topics.
I suggest we stop and consider the true meaning of the word "expert" before we invoke its common use in our vocabulary and text. That's my final thought on the subject.
Richard "Sal" Salcido, MD
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