Even as a med student, I was struck by the discrepancy between how much the junior doctors (particularly the interns and second-year residents) seemed to know, and how much the more experienced doctors knew: with few exceptions, the junior doctors seemed to know a lot more. Or at least, they would always have a definitive answer at their fingertips. Such was their apparent understanding of human pathophysiology that they were usually able to offer plausible, immediate explanations of anything, make a rapid assessment, and move on.
In contrast, the expert physicians – the doctors who had spent decades of their lives treating particular types of patients, and studying a specific disease – tended to be far less definitive, and much more likely to say, “to tell you the truth, we really don’t know.” If a patient responded in a certain way to a new treatment, the experienced doctor is more likely to say “well, that happens sometimes,” while the second-year resident would more likely say, “of course we expect that, it’s because …”
I did most of my clinical training after completing my PhD, which focused on the relationship between several proteins involved in intracellular transport, and I was struck by how difficult it was to define with precision how a handful of proteins interacted, even when I was able to study these proteins essentially in isolation in a test-tube – an extremely reduced system. It was a struggle to say with certainty exactly what was going on (though the results – here, for instance – seem durable, at least to this point).
