Editor`s Opinion: Experts

   "There is great skill in knowing how to conceal one's skill." - Francois Duc de la Rochefoucauld (1613-1680)

   If Monsieur de la Rochefoucauld had the opportunity to observe expert clinicians, he probably would have used them to prove his point. Only experts know how to write two words in a patient's chart after making 15 mental notes and assessing 15 variables. Experts simultaneously talk to a patient, remove a leaky ostomy appliance, and flip through their mental Rolodex of dozens and dozens of pouching options to try. Their "I'm just going to change this dressing" really means that they will: a) assess the patient's general health status and how changes may affect his or her potential for healing; b) determine how well the currently used product worked for this particular patient; c) evaluate what effect the dressing(s) had on the wound condition and surrounding skin; and d) decide which treatment options would best meet current patient and wound needs. The only time experts realize how much they know is when someone asks: "Why are you doing this?"

   Expert clinicians are really adept at concealing their skills. They are so proficient at this that, not too long ago, hospital administrators bought every word their consultants sold them about replacing experienced staff members with "multiskilled" nonprofessionals. Because even historical mistakes are often repeated, remembering - and learning from - this colossal mistake is imperative. Indeed, it may be particularly important for the clinician who cares for people with chronic wounds, fistulae, ostomies, and incontinence to remember what happened in the 1990s because we are, for the most part, a humble lot.

   Maybe we have been conditioned to be humble because most of what we do is not glamorous, sexy, spectacular, or even something the patients want to talk about. You will hear stories about orthopedic surgeons and cardiologists everywhere. You may hear some comments about gynecologists or dermatologists - providing, of course, that the person went to see the physician for something that can be discussed in public. But beyond the confines of a waiting room, how often have you heard men talk about their urologist and prostate problems or listened to a public conversation about someone's excellent incontinence or ostomy nurse?

   Dr. Patricia Benner recognized experts when she saw them. She documented the work of a wound ostomy continence nurse to help illustrate the concept of expert nursing.¹ The security guard at the recent Symposium on Advanced Wound Care in Baltimore knew experts when he saw them. Clinicians at a local wound care center saved his leg (and his job) and he was delighted to meet the needs of "the good folks at this meeting." Our jobs may never be spectacular (bodily fluids and skin conditions rarely evoke images of glamour) but recognizing and claiming our own expert status will go a long way toward improving care - in no small way because an attitude adjustment will help lift the veil of embarrassment and secrecy often associated with the conditions we encounter.

   Summarizing her wound care observations, Dr.Benner writes: "The knowledge embedded in this domain is hidden by strictly procedural descriptions that do not take into account the variability and thoughtful adaptations that must be made in administering and monitoring these interventions."¹ We are experts at concealing our skills and many of our patients are experts at hiding their conditions. Both need to change to facilitate a cure for this situation. Let's start with clinicians healing "thyselves", shall we?