Monday, 18 February 2019

On the nature of expertise

Photo montage of an IV bag & pump, a home blood pressure monitor, & a medication blister pack

There’s been a lot of online conversation lately about the nature of expertise and what it means in the health research world. There are some who posit that the word ‘expert’ needs to stay in firmly in the lane of those who hold MDs and graduate degrees. They assert that ‘experts’ are the people who have finished serious courses of study and deserve that moniker. It has been further proclaimed that patients and families who use the term ‘experts’ confuse the meaning and this leads to the death of expertise.

Frankly, I’m confused. 

It has been several years that I’ve been participating as a partner in health research and quality improvement endeavours. At no time, did I think to imagine that I was an expert in healthcare policy, metabolic bench research, genetics, or psychology (in the latter, only the armchair type on my friends). However, I found that what I (and my patient partner co-investigators) brought was an expertise that was previously inaccessible to the researchers we worked with. While clinicians and researchers were experts in their fields of study, they had no idea how their patients and their families navigated the real world of health care, disability, caregiving, and chronically ill life. My knowledge (and that of other patient partners) – hard won through years of (challenging) life experience, provided a perspective on many areas of research from formulating questions, to data analysis, to knowledge translation. This patient partner perspective was not one that other research partners could acquire through any course of (formal) study.

In fact, if you look at the Merriam-Webster dictionary, ‘expert’ is defined as ‘having, involving, or displaying special skill or knowledge derived from training or experience’. This definition respects that both the clinician/scientists and the patient partners have equal right to the title of expert. It respects that there are different ways of acquiring expertise, and areas of expertise.

Does calling patients experts mean the denigration of that label of expert? Will that mean that people will no longer respect ‘true’ (i.e. scientific) expertise? Well, this is where the argument against calling patient partners experts falls down.

Patient expertise does not have to diminish scientist/clinician expertise.  Both types of expertise can co-exist together. Think of the world of arts where the master crafter doesn’t deny the artistry of a classically trained artist and a (secure) classically trained artist doesn’t reject the artistry of master craftsmanship.  They can both co-exist in harmony.
Those with wisdom respect that there are others that have access to knowledge they don’t have, and they seek it out and respect it. And while I’d like to think that labels don’t matter, in the hierarchical world of health care, healthcare research, and healthcare policy, giving respect to patient partners where it is due has been a long time coming.

I hold knowledge that is important to improving health care systems and research. I equally know that clinicians and researchers hold knowledge that we need to make health and healthcare better. Respecting each other’s expertise is key in making better decisions together. 


  1. This is a wonderful post, thank you Isabel!

  2. Oh, yes! You have precisely and beautifully captured the point in a thoughtful fashion that should offend no professional experts, Isabel.

    You had me at the Merriam-Webster dictionary definition: "an ‘expert’ is defined as having, involving, or displaying special skill or knowledge derived from training or experience".


  3. I wrote an article in Paediatrics and Child Health (about the relationships between parents and paediatricians) in 2009 in which I said "Parents were, of course, aware of and grateful for the medical expertise of doctors, but they also wanted their own profound knowledge of their children and their expertise recognized and drawn on." I think I know why I and other parents felt we had to claim and assert expertise, but since then I've come to think of that as something of a trap. Experiential knowledge is often at least as valuable as expertise and doesn't need to be "converted" into academic terms as when one well-meaning hospital CEO said the parents of the children in her centre all have "expertise in their children." I know my child MUCH better than any healthcare professional does, but the analogy with the kind of knowledge an academic has in his or her field of expertise strikes me as all wrong.

    In the article to which I think you're referring, Isabel, I never suggest only MDs and academics can be experts. In fact, I said I know patients, especially (but not only) those with rare conditions, who are indeed experts. And I certainly agree with you that expertise can come from experience--it almost always does--but experience doesn't necessarily or even usually result in expertise.

    1. I thought when I posted the comment above I thought I'd be identified. In case it's not clear, I'm Frank Gavin.

  4. I'm surprised this can even be a subject of debate. If saying "I have a PhD in patient experience" got pushback from people holding doctorates, I wouldn't be surprised. (Disappointed though - c'mon PhDs, it's just a figure of speech, nobody's taking it literally.) But 'expert'? Who's an expert in patient experience, if not a... wait for it... super experienced and knowledgeable patient?


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