Three Types of Expertise

It's commonly accepted that there are two types of knowledge - "knowledge about" and "experience doing." The former can be acquired by studying, but the other kind of understanding comes through hands-on experience. Both are necessary. Conventional wisdom favors real world experience over book learning. But the ability to step back from a situation and objectively examine all your options requires both kinds of knowledge.

I'm a big fan of my kids' pediatrician, Dr. Joe. A good while back, before my oldest could speak, she suddenly stopped eating. She would literally burst into tears whenever she put anything in her mouth. Even a sip of juice would spark a painful outburst. As new parents, my wife and I were confused and worried. But when we brought her in to Dr. Joe, he identified the problem with one glance inside her mouth. She had stomatitis on the back of her tongue - a painful infection that went away in a couple of days.

That experience got me thinking - you might know enough about stomatitis to pass exams medical school, maybe even do well in a pediatric internship, but with the average doctor seeing scores of patients a day, can you catch it and diagnose it correctly within seconds on the first visit? That's the difference that practical experience makes. Dr. Joe knew that the infection is most common in one and two-year-old children (all that drooling gives a lot of opportunities for oral infection). What's more, Dr. Joe's protocol for a pediatric exam led directly to the tell-tale symptoms on the tongue.

I'm not saying that a younger, less experienced doctor would have missed the call. But this is just an example of the difference made by decades of practical experience.

Here's another example: when our second child was a newborn, he was feeding irregularly so he lost more weight than he should have. Dr. Joe put us on a strict feeding schedule, which we followed precisely for the next four days. At our next visit, the nurse weighed the baby and entered his weight on the chart. According to the chart, it seemed that our baby was continuing to lose weight. Dr. Joe interviewed us in detail. Had we stuck to the feeding regimen? We assured him that we had. Well, he said, there's only one explanation. He went over to the infant scale, calibrated it carefully to zero (which the nurse had forgotten to do), and weighed the baby again. Much to our relief, the baby had in fact gained weight.

In our most recent visit to Dr. Joe, I encountered a third kind of expertise. Our younger child had developed a respiratory infection, and Dr. Joe prescribed the appropriate antibiotics to treat the infection, as well as medicine to reduce the swelling of the airway, to facilitate breathing. He was adamant that we monitor the boy's health very carefully (you don't mess around with respiratory infections, he advised us) and come back for a follow-up visit in two days. The follow-up visit was with one of Dr. Joe's colleagues, and I was impressed by how much her protocols and treatment were in synch with Dr. Joe's. What's more, she told us that this respiratory bug had been going around for more than a month and it was a tough one. It might take two rounds of antibiotics, but with consistent treatment we would clear it up.

That led me to think about the third kind of expertise - an awareness of what's currently happening in your field. In a larger practice, with a team of doctors that communicate well, there's a collective intelligence that's aware of the most currently relevant information. Later, as the current bugs and drugs and research are displaced by newer issues, the "currently relevant information" becomes "experience" - which might be summed up as "previously relevant information that is now possibly future-relevant experience."

We take this transformation for granted - it's captured in the heads of doctors in a practice. But if you were to look for it in the practice's records - those enormous shelves of patient charts, you wouldn't find it.

In the business world, one of the key benefits of the new "Enterprise 2.0" technologies is that they give knowledge workers an effective means to complement their "book knowledge" and official reports with the other two kinds of knowledge. People can communicate their first-hand experience in a timely manner, so relevant expertise is both shared and discovered more easily. In addition, communication is more current and timely than it could be in tradition systems that were designed to archive documents. Inevitably, a system that works this way will seem more conversational in nature, which might give the impression that it's less "professional." But to dismiss conversational communication as less professional is to mistake form for substance.

The Tayloristic mind-set sees a water cooler conversation happening in a social network and thinks "those people should get back to work." But in fact, knowing each other - and what each of us is currently working on or seeing in our work - that is our work. Perhaps by thinking about the three types of expertise we might help people to understand this idea better. What do you think?