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The Limits of Expertise

quillette.com

21–30 of 66 posts

Re: The Limits of Expertise

#21
post #12

I'm committing the sin of commenting w/o having read the article yet, so this might be duplicative or orthogonal, but: Without feedback, there is no real expertise. Most experts are in domains w/o feedback, so they are mostly full of shit. Good blog posts exploring this topic a bit: https://infoproc.blogspot.com/2018/05/dominic-cummings-on-fi... (above is a summary/intro to following:) https://dominiccummings.com/201…

It also occurs to me that there's an interesting meta-commentary here, which is that an outlet like Quillette can publish an article like this with such obvious counterarguments. They don't even have sufficient editorial feedback to understand that they don't understand.

Re: The Limits of Expertise

#22
post #17

> Engineers, surgeons, pilots, all these kinds of ‘trusted’ experts operate in closed systems. Unfortunately, the prosperity of the "traditional medicine" industry is evidence that people don't even trust their surgeons/doctors.

Yes, I've absolutely lost trust in doctors and physicians. My wife suffered a minor knee injury while we were trail running last year. She went to a specialist (orthopedic surgeon) who performed an x-ray and told her he couldn't see any damage. He formally diagnosed the problem as chondromalacia patellae ("runner's knee") and sent her on her way with a cortisone shot and a referral to a physical therapy practice.

As it happens, the cortisone shot significantly increased her discomfort and pain pretty much permanently. She was warned it might be more painful for two weeks, but she still has to ice it regularly. She also left the physical therapist she was referred to because the attentiveness and level of care was lacking (she was often left with an intern, and there was no itinerary for weekly progression to recovery). She didn't see any progress on twice weekly appointments.

This left her pretty despondent, unfortunately. It wasn't until I went to several running subreddits and asked for strong recommendations for results-oriented physical therapists that we found a practice where she's actually seeing progress. After nearly a year she's just now starting to run again. Throughout this entire process, neither of us have felt particularly cared for or listened to. We're fortunate that we can spend the money on a place that doesn't accept any insurance just to see really strong care.

What really drove me up a wall personally is that this level of expertise does exist. Professional athletes routinely recover from far more significant injuries because they're under the proper direction and recovery regimen. But that kind of expertise isn't easily available even if you know to look for it. Instead people get shuffled around from one crappy doctor's office to another by their uninterested insurance agency, until they gradually lose hope and stop bothering. Then they end up in they're late 30s and 40s unable to exercise because they got a bad whatever in their 20s that no one cared enough to help them through.

It's also difficult to trust a profession which appears to systematically disrespect clients' time. This past week I had a morning appointment with my doctor. Despite arriving on time I didn't actually get to see him until two hours later. There's nothing I can really do about it, because I can't find any indication it will be like this until after experiencing it with a doctor. It's not as though this is an unsolved problem. Restaurants routinely plan to have reservations available on time so they're ready for guest arrival.

I can recognize that doctors have much more domain knowledge and experience than I do. But that makes it even more grievous when I have to pick up their slack in patient care. The level of accountability and care seems to be completely hit or miss.

EDIT: Thinking about it more, the article's premise about the trustworthiness of "closed-system experts" seems to be incorrect across the board. As an example, I once had a malfunctioning air conditioner that survived through two summers and three different mechanics. Apparently fixing a Honda Civic's air conditioner was too complex a task for their expertise. These days I just take my car to the dealership so I know it's fixed. I don't even mind overpaying as long as I don't have to deal with the anxiety of repeated disappointment. I can't imagine the desperation and anxiety of those who are at the mercy of these kinds of experts for much more serious problems. That kind of frustration is how you create supervillains.

Re: The Limits of Expertise

#23
post #17

> Engineers, surgeons, pilots, all these kinds of ‘trusted’ experts operate in closed systems. Unfortunately, the prosperity of the "traditional medicine" industry is evidence that people don't even trust their surgeons/doctors.

Yes, I've absolutely lost trust in doctors and physicians. My wife suffered a minor knee injury while we were trail running last year. She went to a specialist (orthopedic surgeon) who performed an x-ray and told her he couldn't see any damage. He formally diagnosed the problem as chondromalacia patellae ("runner's knee") and sent her on her way with a cortisone shot and a referral to a physical therapy practice. As…

Can I ask you for the subreddits you used? (Or, if you're in the Bay Area, whom you're working with :)

I'm still suffering from a knee thing, and I've been through 3 diagnoses so far, with no results. A results-oriented PT would be a lovely person to meet. (Most PTs seem in no way able to adapt to any changes, or figure out which exercises help)

[e-mail in profile.]

Re: The Limits of Expertise

#24
I don’t think I buy the author’s explanation, at least not entirely. There are a lot people who don’t respect expertise on things like vaccination.

People have a hard time accepting expertise when the claims of experts are probabilistic instead of definitive. (Because they will perceive experts as wrong when 50% things don’t happen. And they will see the experts as wishy washy in any case.)

People have a hard time accepting expertise when the claims of experts are inconsistent with philosophical or political positions that are core to people’s identities.

Re: The Limits of Expertise

#25
post #17

> Engineers, surgeons, pilots, all these kinds of ‘trusted’ experts operate in closed systems. Unfortunately, the prosperity of the "traditional medicine" industry is evidence that people don't even trust their surgeons/doctors.

Yes, I've absolutely lost trust in doctors and physicians. My wife suffered a minor knee injury while we were trail running last year. She went to a specialist (orthopedic surgeon) who performed an x-ray and told her he couldn't see any damage. He formally diagnosed the problem as chondromalacia patellae ("runner's knee") and sent her on her way with a cortisone shot and a referral to a physical therapy practice. As…

If you concluded, based on these experiences, that the person selling essential oils to cure cancer is as useful as an oncologist you need to examine your thinking.

Re: The Limits of Expertise

#26
post #23

Earlier quoted context omitted.

Yes, I've absolutely lost trust in doctors and physicians. My wife suffered a minor knee injury while we were trail running last year. She went to a specialist (orthopedic surgeon) who performed an x-ray and told her he couldn't see any damage. He formally diagnosed the problem as chondromalacia patellae ("runner's knee") and sent her on her way with a cortisone shot and a referral to a physical therapy practice. As…

Can I ask you for the subreddits you used? (Or, if you're in the Bay Area, whom you're working with :) I'm still suffering from a knee thing, and I've been through 3 diagnoses so far, with no results. A results-oriented PT would be a lovely person to meet. (Most PTs seem in no way able to adapt to any changes, or figure out which exercises help) [e-mail in profile.]

> [e-mail in profile.]

You are the second person in the past week who has invited me to email them here, and both times there wasn't actually an email address in the profile :)

Nevertheless I'm happy to answer here in case it helps anyone else: I asked on /r/running and /r/AdvancedRunning. The latter was the one that really gave strong recommendations. I'm not in the Bay Area (NYC), so I can't comment on that area.

Re: The Limits of Expertise

#27

> Nobody says, “I want someone unqualified to be my president, therefore I also want someone unqualified to be my surgeon.” Nobody doubts the value of the expertise of an engineer or a pilot. If planes were crashing every other day, you'd better believe people would be doubting pilots. Trust is earned , not owed. And the reason people have trouble trusting our political and economic elites is because they keep crashi…

That's almost a rhetorical question, but...

How do you define "crashing the plane" here ? There's only one plane and it's still going. History hasn't ended.

Re: The Limits of Expertise

#28
post #12

I'm committing the sin of commenting w/o having read the article yet, so this might be duplicative or orthogonal, but: Without feedback, there is no real expertise. Most experts are in domains w/o feedback, so they are mostly full of shit. Good blog posts exploring this topic a bit: https://infoproc.blogspot.com/2018/05/dominic-cummings-on-fi... (above is a summary/intro to following:) https://dominiccummings.com/201…

The reason "experts" have such a bad reputation is that anyone who is a qualified expert in something has a more specific title relevant to their expertise, where their reputation can be judged: Scientist, Professor, Author, Pilot, CEO

Re: The Limits of Expertise

#29

Earlier quoted context omitted.

Yes, I've absolutely lost trust in doctors and physicians. My wife suffered a minor knee injury while we were trail running last year. She went to a specialist (orthopedic surgeon) who performed an x-ray and told her he couldn't see any damage. He formally diagnosed the problem as chondromalacia patellae ("runner's knee") and sent her on her way with a cortisone shot and a referral to a physical therapy practice. As…

If you concluded, based on these experiences, that the person selling essential oils to cure cancer is as useful as an oncologist you need to examine your thinking.

I didn't conclude that. On the other hand, based on my experience I did conclude that the American healthcare system is designed to favor those who can afford to value their time over their money. It's not much comfort that a doctor has the right knowledge if they're too apathetic, overworked or inexperienced to get results that are any better than essential oils. At least with essential oils I know they won't work instead of being let down by a well-credentialed veneer of expertise.

Re: The Limits of Expertise

#30
post #17

> Engineers, surgeons, pilots, all these kinds of ‘trusted’ experts operate in closed systems. Unfortunately, the prosperity of the "traditional medicine" industry is evidence that people don't even trust their surgeons/doctors.

Yes, I've absolutely lost trust in doctors and physicians. My wife suffered a minor knee injury while we were trail running last year. She went to a specialist (orthopedic surgeon) who performed an x-ray and told her he couldn't see any damage. He formally diagnosed the problem as chondromalacia patellae ("runner's knee") and sent her on her way with a cortisone shot and a referral to a physical therapy practice. As…

You're really comparing the availability of a fleet minimally skilled servers and a moderately skilled line cooks, to a single medical doctor's appointment?
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