As we witness the global consequences of expertise rejection, particularly in the United States, I've been considering what truly characterises expertise beyond just specialist domain knowledge and experience – a question at the heart of anaesthesia and critical care practice.
Many doctors are first drawn to anaesthesia as a specialty because we desire control. We imagine ourselves controlling airways, physiology, and pharmacological interactions – sometimes, we even fancy we have some control over our surgical colleagues.
Yet we don't actually control any of these things. Instead, we modify, ablate, and amplify, working within a complex interaction between the patient, physiology, surgery, and our interventions. Our expertise lies not in absolute control but in understanding and adapting to uncertainty.
As news from the US shows a country embracing the "find out" phase of cascading bad decisions (some people just need to touch the stove to learn it's hot), a culture of expertise rejection dominates. This rejection exposes itself in curious ways, including assumptions that success in one field, say, building electric cars or reusable rockets, represents translatable expertise to other specialist fields.
The world is one of shades of grey, and anaesthesia is no different. Embracing uncertainty requires being comfortable with the potential for change and then preparing for and adapting to this change. Anti-experts respond to uncertainty by asserting their will onto reality, mistaking their desired outcome for reality itself. We see this in anaesthesia when something is going very wrong, yet an overwhelmed anaesthetist is unwilling to accept the situation and continues to try the same futile intervention. Airway emergencies particularly highlight this risk.
While many of the world's biggest challenges require cross-discipline insights, humility is essential lest we mindlessly dismantle Chesterton's fences, letting the monsters inside escape. We must accept uncertainty when we lack expertise and learn why the bloody fences are there before we recklessly tear them down.
Aside from their casual callousness and banal cruelty, these anti-experts are dominated by their infallible certainty. In contrast, true experts are intellectually humble, even when they are sure—perhaps especially when they are sure.
Today, we find ourselves at a local maxima of peak uncertainty. Another pandemic is brewing in North America, spreading through poultry and dairy cows, with 15% of the US chicken population already culled. Global economic uncertainty is at a 30-year high, greater than the beginning of the COVID pandemic and now fuelled by wars in Europe and the Middle East. All this while the US toys with authoritarian descent, making me wonder whether the lasting legacy of the country of Washington and Lincoln will be to serve as a warning to future generations.
The expert's approach to uncertainty cannot be passive acceptance or paralysis. Instead, uncertainty demands preparation by considering possible outcomes, decision trees, and probabilistic thinking. Rather than falsely believing we can bend reality to our will, true expertise means adapting our responses and behaviour to reality. This combination of preparedness and humility in acknowledging uncertainty defines the expert's mindset and shows why expertise remains crucial for navigating our complex world.
