From The Editor
Dr Leong Khai PangEDITORMedical DigestYou wouldn’t expect a free-of-charge medical magazine to supply the key tobeing an über-doctor, would you? Read on.Beginners do not capture the likeness of objects they want to portray. Later, theirdrawings start to look like the real thing. As the artists further mature, paradoxically,the resemblance is again tenuous. Picasso’s works, in the museums in Barcelonaand Paris, showed that even he had to go through the three stages in turn.Usually, we talk of three levels of expertise: novice, competent and expert.Guidelines and rules are meant for people that straddle the competent and expertstages. Expertise is shown by consistently superior performance to that of theexpert’s peers, concrete results and measurable outcomes (Ericsson KA, PrietulaMJ, Cokely ET. Harv Bus Rev 2007; 85:114-21, 193).Training and practice bring us to the expert level. “It is probably self-evident toinitiate that growth in expertise is dependent upon experience. What is not soevident is that experience in itself is not sufficient ... For all but the few effortlessself-learners, changes in expertise need reflection and deliberation,” says AdvancedConsulting in Family Medicine (Radcliffe Publishing Ltd, UK 2009). Consequently,it is hard for us to become better after we have completed training becausemedical practice primarily consists of personal interactions between the patientand the doctor, usually with no external critique or audit.Can there be skill levels above the expert? What if the medical problem wandersinto areas of great uncertainty and risk (Innes AD, Campion PD, Griffiths FE.Complex consultations and the 'edge of chaos'. Br J Gen Pract 2005; 55:47-52)?How does the doctor diagnose and treatment an illness not in the radar?Some writers propose two extra levels: the master and the visionary(http://doc.utwente.nl/58083/1/levels_of_expertise.pdf). I quote: “The …‘visionary’consciously strives to extend the domain in which he/she works. The worlddiscloser develops new ways things could be, defines the issues, opens newworlds and creates new domains …operates more on the margins of a domain,paying attention to other domains as well, and to anomalies and marginal practicesthat hold promises for a new vision of the domain.”In my view, precision, economy and preternatural ability (seemingly) are a fewtraits of the crack medical practitioner. He or she is right most of the time,regardless of the complexity of the case. He or she may propose an unusualdiagnosis, but it is appropriate (it’s easy to do so and be wrong). He or she doesnot over-investigate or over-treat. Analogously, Yasujiro Ozu did not need dollyshots, fades, dissolves, voice-overs or special effects to make the greatest moviesever made. We make decisions with logic and also through intuition (perhapssomething very difficult to teach). The über-doctor knows the limits of each anduses them in the right proportion. On 10 September 2011, Djokovic beat Federerin the semi-finals of the US Open. After saving two match points, everything hungon one shot. Djokovic said, “The forehand return, I cannot explain to you becauseI don't know how it happened. I read his serve and I was on the ball and I hadto hit it hard, and it got in, luckily for me.” These doctors exist; we have colleagueswho make correct diagnoses that we could never make, and avoid problems thatwe could never see coming. What we need is not longer lists of differentialdiagnoses, but more incisive decision-making; not more investigations, but moreresoluteness; and not more knowledge, but deeper understanding.We can be better doctors. May we always be growing and learning and thinking.
While every endeavour is made toensure that information herein isaccurate at the time of publication,Tan Tock Seng Hospital shall not beheld liable for any inaccuracies. Theopinions expressed in this publicationdo not necessarily reflect those ofTan Tock Seng Hospital. The contentsof this publication may not bereproduced without writtenpermission from the publisher.
We value your feedback.Please email your questions,comments or suggestions to:firstname.lastname@example.orgPlease also contact us for notification ofchange of postal address orfor requests of additional copies.
Dr Leong Khai Pang
Dr Jackie TanDr Jaideepraj RaoDr Lee Cheng ChuanDr Khian Chong YawDr David FooDr Gregory KawDr Nikolle TanDr Ernest KwekMs Lim Wan Peng
Ms Michelle Lee
Ms Zaonah Yusof