Jack of all trades, Master of none

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It is surprising to me how often I hear this used as a compliment still. Although it is intended as a compliment, it is most assuredly a criticism not an aspiration. At most we should hone a handful of crafts, a handful of things, because the opportunity cost of trying to learn a little bit about everything is knowing everything (or at least, a lot) about a single thing. An inch deep and a mile wide.

Consider how we got to where we are today. Specialization plays a huge role in that. Look at the things around you. Few, if any of them could you have made by yourself without the help of many experts or professionals. Most of us could not build a computer from the ground up, and even if we could we certainly could not manufacture the necessary parts alone. Most of us could not build a car even if we had all the rights parts and a detailed instruction manual. Most of us are probably not doing ourselves (or our doctors) a favor by surfing Web MD or watching Dr. Oz to try to self diagnose what seems to be ailing us. Most of us cannot act well, sing well, or write well. Most people cannot grow enough food or gather enough provisions to keep themselves fed. If we each tried to make our own clothes the result would almost assuredly be extremely time consuming and uncomfortable.

I was listening to the Director of the National Center for Advancing Translational Sciences at the NIH. He commented on the fact that there are over 7,000 diseases. SEVEN THOUSAND, with more being discovered every year. As a medical student with books and books just summarizing the most common of these diseases this can be discouraging. The reason there are so many advocacy groups for less common diseases is that physicians cannot keep the signs and guidelines for every disease in their head all at once. The key is knowing when and who to ask for help.

The reason we have specialists is because they can have in depth knowledge about a specific area without concern for everything else. In the Emergency Department or with the primary care physician, the task is to know the most common diseases, recognize when someone is acutely ill, and then know who to call (or page) in each instance. A primary care physician memorizing large lists of genetic loci and rare neurologic conditions is not benefiting his or her patients through this impressive, but futile efforts. Stabilize, recognize, and treat or refer. The emergency physicians and primary care physicians are experts in that task! Even the more “general” medical disciplines are still specialists as it pertains to their job.

The physician however should NOT be working to be the best accountant, or computer programmer, or car mechanic. Physicians fixing their own cars could probably cause enough accidents to generate a whole new medical speciality.

Find what you want to be an expert in. Develop your craft. Hone your skills. And, be content with being ignorant in many areas of life. That is the cost of specialization and contributing to society as a whole. That is the cost of progress.

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