“An expert is one who knows more and more about less and less.”
Nicholas Butler
OK. Apologies to the Latin experts out there. I’m not one, as must be obvious, but hopefully my pidgin Latin roughly conveys its intended sense, which is to see beyond conditioning, “expel what is expected through experience” (though the grammar probably puts it more in the realm of “my postilion has been struck by lightning”).
I was thinking about last week’s post and this business of living mindfully rather than relying on autopilot: of the distinction between expectations/conditioning/assumptions/”expertise” and reality, how expectations are infused with projections, and the expectations and assumptions we have in respect of various man-made “systems”, whether mechanical, administrative or conceptual. I couldn’t help noticing how close the Latin expectare (“await, hope”) is to expectore (“expel from the mind, literally, get it off your chest”) despite the two words being of different derivation (ex- “out” + spectare “to look” vs ex- “out” + pectus “breast”), and how the word expert comes from ex- “out” + peritus “tested, experienced”.
This was all brought together quite eloquently this week when we went to renew a conventional medication prescription. When we left the hospital last month, we were supplied with a form with full instructions for what should be repeated and for how long, and I took this in to the local medical practice on Monday as it normally takes 3 days for them to process repeat prescriptions.
First off, the medications weren’t waiting for us at the pharmacy as we’d been assured they would be. So we went up to the practice where they couldn’t figure out why this had happened, but printed out a prescription for us to take back to the pharmacy to get filled out on the spot.
As we were getting back into the car, I thought I’d better just check it over. I even felt slightly churlish doing so. Aye well. But as well I did. One of the medications prescribed wasn’t what had been specified on the hospital form. So back we went again. They checked it (this took the combined energies of 3 receptionists) and said the doctor had entered it on the database that way. They surmised this must have been because there wasn’t a generally available medication complying with the dosage specifications – the hospital pharmacy must have supplied us with one they’d made up themselves – so he’d chosen the nearest thing he could find that could deliver the same amount of active ingredient.
This all made perfect sense. The only thing was, the consultant had written very clearly, in block capitals in the margin of the form, the trade name of the tablets to prescribe. They’re widely used for a common condition. Even if the doctor wouldn’t necessarily expect this medication to be prescribed in this circumstance, the instructions were perfectly clear. Even though the receptionists accepted the doctor’s expertise and had previous experienceof instances where the hospital pharmacy had made up their own medications, the instructions were perfectly clear. I asked to see the form and pointed out the instruction to them. Once they’d looked at what was written next to my fingertip, everything was straightforward.
Armed with new instructions, we went back to the pharmacy where they filled out the prescription. It wasn’t until I got home that I looked at the bottles and saw that, contrary to the form’s instruction to renew the prescription for 2 weeks only, they’d provided 2 months’ worth of one medication and only 11 days’ worth of the other.
If that many mistakes can occur with a single form that a doctor, 3 medical receptionists and a pharmacist – all very nice and I’m sure generally competent people – had all failed to read properly, it really makes you wonder how many are made on a daily basis and never picked up. If I, as the only “non-expert” in the process, could read it without a problem, it surely couldn’t have been that difficult to decipher?
“The trouble with specialists is that they tend to think in grooves.”
Elaine Morgan
But there you go. Systems, all systems, develop their own circular logic; their conditioning, their expectations, their assumptions. Can we trust their experts to pragmatically accommodate anything that falls slightly outside their expectations? It seems not. Not least because it’s self-evident that the greater the level of “expertise”, the deeper the groove being followed.
This isn’t to say that experience isn’t valuable, and repeated experience more so. It’s how we learn, how we become proficient, expert. You wouldn’t get your bicycle fixed by someone who’d never seen one before. Repeated experience, predictability, is the basis of the vast majority of our science and technology. In many areas it’s even become the ultimate arbiter of what’s considered ‘real’ and what isn’t. But what this perspective turns a blind eye to is the domain of the unique and individual, the unpredictable, the chaotic, which is as equally inherent in any uncontrolled situation as that which is predictable. This constantly stares us in the face, yet it’s our very “expertise” – often taken as an indicator of intelligence – which blinds us to it until someone comes along and points it out.
“If an elderly but distinguished scientist says that something is possible he is almost certainly right, but if he says that it is impossible he is very probably wrong.”
Arthur C Clarke
This has considerable implications for the debate surrounding (so-called) evidence-based medicine and the efficacy of CAM therapies. While this may seem a very superficial example of conditioned thinking (and straightforward human error) which is perhaps less relevant to serious subjects that have been examined more closely and in greater depth, closer scrutiny of the debate shows no less prevalence of rigid expectations, inability to see the obvious, circular logic and erroneous supposition.
“Experts built the Titanic; amateurs built the Ark.”
Unknown
