am I an expert yet?

In the field of academic general internal medicine, a far-reaching range of discourse defines our daily reality.  We thrive on diversity, and, as befitting our clinical world of primary care, where we are the gateway for….everything…a breadth and depth of knowledge is encouraged and expected.

If a patient comes to us with Parkinson’s disease, we must initially asses whether it is truly the diagnosis or whether other conditions are mimicking its symptoms.  When the complaint is swelling, we look to several different organ systems as possible culprits.  If seven subspecialists and a prior primary care physician have not found the etiology of a disease, we need to know when to keep looking and when is the appropriate time to stop and help the patient make peace with himself.

In my academic world, my neighbors in my office suite are each generalists in practice, and purse research on: healthcare disparities, obesity in those with mental health disorders, how neighborhoods affect health.  And this just within 10 feet.  Broaden your view to the entire floor of my office, and you will quickly encounter healthcare policy, genetics, diabetes, the intersection of psychology with the treatment of sickle cell anemia and ethics in our global health systems.  It is impossible to be well-read on everything, but that is why the environment of academics is so coveted and stimulating.  Each time I step out of my office, I encounter something that is new and potentially revelatory.

This is the draw and timeless appeal of academia.  The quote on my wall is taken from Albert Szent-Gyorgyi, the 1937 winner of the Nobel prize:  “Discovery consists in seeing what everyone else has seen and thinking what no one else has thought.”  A golden ideal, this swirls above my head as I pour over the details of our latest manuscript or sharply draw in my breath as I receive the response to my article submission.

All the while, my hours are peppered with more tangible questions from my trusting patients, which flow in throughout the day, night and weekend.  I read about this medication on the internet, what do you think of it? they query.  My foot hurts, I have a rash, my blood sugars are our of whack, I have just been so incredibly tired for the past year and no one knows what it means…can I come in and see you?

This quick alternation between the relatively new rigors and stamina required of academic life, and the more familiar patient concerns and grueling life as a health care provider can aid and inform each other, however, their intersection produces a different kind of strain.  I often pass my colleagues in the hallway, those at the same level in training, and we shake our heads at one another while simultaneously considering new projects and that difficult patient and the homework for that extra class we are taking.  Our time burden is noticeably shifted from what it would be if we were seeing our patients full-time, and allows for the flexibility we enjoy in collaborating on papers, traveling to conferences, and taking on extra training.  This fractionaction of time, however, leads to the feeling that I am a student of all and master of none. While anyone can benefit from more practice in his field of choice, our lives force us to feel like novices at everything until we have spent three times as long as someone who has chosen to focus on one part.

For my friends enmeshed in daily clinical care, their work provides new challenges as unique as each patient, and now, several years out of residency, they have become comfortable with their knowledge base in patient care.  On the other hand, those around me who chose to pursue PhDs instead of MDs now have the knowledge of epidemiologic methods and statistics flowing through their veins while I still often struggle to solidify the same content acquired more recently.  I love the multifacted nature of my work, but it can often be a demon – splintering my attention and focus to different skills, requiring years to gain as much expertise in everything as it would have taken if I had just chosen one.

I think I will always ponder that elusive balance of stress and confidence, inspiration and boredom, broad engagement and focus.  It is both being an “expert,” yet having enough of an open mind to look at new means of clinical practice and investigation that I crave.  Am I an expert yet?  I’m working on it, and probably will be for the duration of my career.  Thoughts and advice are most welcome!  Until then, my searching continues.

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