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Expertise is special skill or knowledge that is acquired by training, study, or practice.

I follow an Orthopaedic surgeon from the US who is of a similar vintage and much of what he posts aligns with my current thinking. I like his posts because they ooze expertise. He is extremely considered when it comes to non-operative care and he himself states how much less he operates these days, as he has become more experienced.

Yesterday, I met an extremely experienced health entrepreneur who’s worked on the business side of healthcare for decades. We were discussing how I am managing the latter part of a surgical career.

I was explaining that I don’t learn a huge amount from additional surgical procedures these days but I still learn an immense amount from seeing my patients. Don’t get me wrong, I’m not giving up surgery at all. I still see patients regularly that really make me have to think hard. The harder I think, the less I operate. Why is it that the more expertise I have, the less I operate?

It reminded me I had got thinking about expertise - there I go again – as far back as 2012. My question was, ‘can patient forums offer expertise?’ so I started looking at them online. I came across people with a condition who would have had plenty of experience or ‘practice’ in living with their condition. Many would have become very knowledgeable compared to the general population. There were, in addition, many who commented and gave advice that was way out of their lane of training. I don’t want to single out any allied health professionals but there were some who would have been trained for example in anatomy and manual therapies but virtually nothing to suggest they were people with the right expertise to advise on getting an MRI scan. The problem was that these two groups may have had huge experience of practice within MSK but that experience was not matched by training and study in the subject. Exposure without prior study, learning and reflection could not be called expertise.

I started to think about where expertise sits in the treatment pathway. I followed what we all do from the moment we start seeing a patient. I came up with a progression from acquisition of many single points of data e.g. twisted knee, medial pain, medial tenderness, swelling. All those data points when put together assume a pattern leading to information e.g. MCL tear, meniscus tear, osteoarthritis. That list is unranked i.e. equal weight is given to all diagnoses. This is where it then starts to get interesting. When that data and information is viewed by someone with knowledge and expertise, they can start to rank them into a list that floats the most likely diagnosis to the top of the pile. The application of training, study and practice improves the ranking. They draw on prior knowledge and experience from exposure to start to see the patterns. Without this, treatment plans are like throwing spaghetti at the wall to see what sticks. In other words, a bit hit and miss. A bit like when we all did our first day at work and floundered to apply our study and training in a meaningful way. Those of you reading this who have qualified will remember how poorly equipped we all were on that very first day.

So back to my original question: can patient forums offer expertise?