How to be an Expert: Narrow Niche or Novel Juxtaposition

I’m a family doc. I do a little bit of everything. I’m good at psych. I often cure diabetes. I handle what comes my way with a few exceptions: I haven’t learned how to treat HIV or Hep C and I don’t feel comfortable about treating most cases of osteopenia and osteoporosis, because I’m still not convinced that something that happens to everybody at a predictable rate is a real disease.

I just posted about two Swedish psychiatrists who each developed a special interest in one disease. I’ll probably never make a name for myself through niche knowledge. I have, however, discovered a previously unclaimed clinical sign, which I would rather not be immortalized for: Multiple pinpoint underwear blood stains are usually caused by pediculosis pubis, “crabs”.

So, the only way I can get famous is probably by somehow connecting the dots between seemingly unrelated facets of medicine or life in general. I find this at least as intellectually stimulating as discovering something new.

One theme that has popped up many times in my writing is what doctors should be like: “Be the Guide, Not the Hero”, “Be the Doctor Each Patient Needs” (a little bit like a chameleon), “The Apostolic Nature of Our Profession” (part clergy and part disciple), “A Samurai Physician’s Teachings” (disciplined and simple), “If You Are a Doctor, Act Like One” (a role model), “I am Not InstaDoc, This is Not InstaMedicine” (a professional, not a robot), “If Not a Doctor, Then What?” (teacher) and the list could go on.

Here, I am shamelessly drawing attention to the second book in my A Country Doctor Writes series, IN PRACTICE – Starting, Growing and Staying in the Medical Profession.

Our role in medicine has changed dramatically since I graduated from medical school in 1979, partly by circumstance and partly by design. Patients’ views and expectations have evolved, the health care industry’s grip and control over us has tightened and our self image and career expectations have slipped. I never heard of physician burnout in the first decade of my career and now I hear or read that word every day, several times.

So, one of the purposes behind my writing is to “think out loud” about what it means to be a doctor, where this profession is headed and if that is what we want for ourselves. I love medicine and feel blessed to be practicing with passion and enthusiasm at my age. My hope is that I might help others see what I see in this role, in this profession, in this calling – not really as an “expert”, but more like a spokesperson.

2 Responses to “How to be an Expert: Narrow Niche or Novel Juxtaposition”

  1. 1 Will October 16, 2021 at 7:27 am

    and that is why we read you. Keep it up; it’s interesting and informative.

  2. 2 Henry Hochberg October 17, 2021 at 10:05 am

    I closed my solo family practice of 30 years at the end of 2019. Still wanting to engage in clinical medicine I answer interesting looking medical job offers that come on the internet, through LinkedIn or in other ways. From reading you Hans, I’m of the impression that our practice style, attitude and demeanor are very similar (although you’re clearly smarter than me!😄). Of all the interviews I’ve gone through for medical positions it is rare I find a position or an interviewer that seems to understand the value of mastering patient care, clinical experience and acumen and the art of medicine. How does “If you were an animal, what kind would you be?” help decide if I’d be a good doc?
    It just all leaves me a little saddened because as medicine becomes more of a business and corporatized what makes it special among careers with personalized human interactions and a real ability to help on a one to one basis may go the way of the dodo bird.

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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.



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