Your patients deserve expertise, not 'good enough'
By Mike Wokasch

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For years, I have been fascinated by the concept of expertise. People working with remarkable combinations of knowledge, skill and experience to produce exceptional results. Results that appear to be extraordinary, perhaps the best you have ever experienced. A performance level and results that might even be considered "best in class" or even "world class."

As healthcare professionals, we may have a tendency to look at expertise in the narrow context of science and medicine. While the implications of expertise may differ, it is important to appreciate that expertise is not defined by academic achievement or job function. The person who can make your burger perfect every time, the incredibly knowledgeable and attentive restaurant server, the meticulously accurate and precise laboratory technician or the electricians and plumbers "who just know" what's wrong and how to fix it — all have a level of expertise that they have developed.

People with real expertise don't necessarily need somebody to tell them they are the best at what they do. And, aside from those who are just arrogant, people with real expertise may not even think or feel they are the best at what they do. They're not just doing their job. They are always trying to be better at what they do.

In fact, they seem to be subconsciously obsessed with being better at what they do. Challenging themselves to be better. Learning and trying new ways to do something, different ways to say something, or make something different that might be better. Not for continuing education credits, not for testing purposes, not to impress anybody, not even because it might mean more money. They just have this inherent drive to be the best they can be at what they do. These people never feel they have reached a point at which they can't improve or be better at what they do. They are not frustrated perfectionists. They just want to get better at what they do.

True expertise is so rare that you recognize it as soon as these people perform their respective job functions. Their exceptional level of knowledge, skill and experience in performing a job function goes well beyond basic competence and "good enough." Unfortunately, we live in a "good enough" mentality world, from the test scores we get in grade school to preparing for job interviews. Granted, some things deserve nothing more than "good enough," but when it comes to your job function, especially as a healthcare professional, is there room for "good enough?"

Outright mistakes are one issue, but "good enough" healthcare implies it could be done better, given the available expertise in the field. Here are some "good enough" examples of what I'm thinking about:
  • A missed diagnosis between two diseases that present only nuance differences symptomatically.
  • Prescribing a broad-spectrum antibiotic where a targeted narrow spectrum product would be more appropriate given the probability of bacteria present.
  • The nurse or phlebotomist who makes several attempts to find a vein for an IV or to take blood samples, subjecting the patient to multiple painful insertions and subcutaneous bruising.
  • The "routine" pre-op surgical scrub (of the patient or of the surgical team) that is so routine as to be "good enough" that contamination occurs but can't be traced back to the offender.
  • Poor bedside manner that compromises patient trust and confidence to a point where they ignore good medical advice.
Iím sure you can think of some "good enough" tasks in your own setting. The point I'm trying to make is that regardless of how good you might think you are at your job, there is probably room for improvement — to perform your job function at a higher level with the opportunity to develop real expertise.

And why is that important? Because, as a healthcare professional, the difference between mere competence and performing your job with expertise could have significant health implications for your patients. In some cases, it could mean the difference between life and death for the patient. The difference could also have career and possibly legal implications for you.

So what does it take to develop real expertise? Moreover, why is it so rare that we recognize it immediately? We'll cover that in the next article.

Mike Wokasch, a pharmacist by training, is a 30-year pharmaceutical industry veteran, having held a number of positions of increasing responsibility at several large pharmaceutical companies including Merck, Abbott, Chiron, Bayer and Covance. Wokasch was also an executive at several technology-based companies including Promega, PanVera and Aurora Biosciences. He is the author of the book, "Pharmaplasia," which explores the changes needed in the pharmaceutical industry as it adapts to healthcare reform.