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Personal Views Personal views

The sins of expertness and a proposal for redemption

BMJ 2000; 320 doi: (Published 06 May 2000) Cite this as: BMJ 2000;320:1283

Rapid Response:

From Socrates to Sackett

To the Editor

Hershey Bell in her letter commenting on the compulsory retirement of
experts missed the very wise contention of David Sackett, an expert in
evidence based medicine and clinical epidemiology about many "experts." As
it is frequent, the Modern History of Knowledge forgets its past and
recommending a "community of truth" approach to create a partnership
between expert teachers and learners is in fact recommending the Socratic
stance. There is often this fear that sharing knowledge is like sharing a
piece of pie . . . But sharing is a different phenomenon in the realm of
truth and medical knowledge. The more it is shared, the more it's added
to. Today in medicine, the wisest of persons, we call them experts, are
ones who like Socrates 2500 years ago or Erasmus before the Reformation
recognize that in reality they are not so wise.

This is the message of Sackett, it is a call against intellectual
arrogance. This intellectual arrogance is still present today (take a
glance at the Bristol cases and many negligent claims). An analogy to the
expert question might also be expressed this way : our Health and Legal
systems (of course I know better about French public hospitals where I
work) leave no room for mistakes. Unavoidable mistakes are simply not
allowed. Therefore mistakes must not be acknowledged. Do we need to stress
that this old professional Ethics is authoritarian and intolerant? Of
course, it remains our duty to avoid mistakes whenever possible. This old
professional Ethics leads especially in medicine to the cover up of
mistakes for the sake of protecting authority. See what happens to the
"whistle blowers."

Sackett gives the message that authority should not be conferred without
question upon knowledge and the knower (i.e. the expert), upon medical
science and the scientist, and upon learning medicine and the learned.
Karl Popper has reported in the most accessible way, especially for us
whose first language is not English, the doctrine of fallibility, to
"emphasize that we are always and usually capable of error and that we
therefore know nothing or only very little in the classical sense of

Our objective conjectural evidence based knowledge goes further beyond
what any one person can master. So there cannot simply be any "expert."
This has been recognized by the Cochrane Collaboration of which David
Sackett was one of the early contributors.

To conclude, the characteristic Sackettic stance is a call for
intellectual modesty and us really have to take him seriously.

Dr Bernard Guyot

Praticien Hospitalier AIHP, ACCA, FSOGC

Chirurgien des Hôpitaux
Spécialiste en Gynéco-Obstétrique

Popper K. In search of a better world. Lectures and essays from 30
years. On knowledge and ignorance. Routledge 1994 : pp30-43.

Evidence based medicine working group- A new approach to the practice of
medicine JAMA 1992 ;268,N°17 :2420-2425 (4 November)

Sackett D Cochrane Collaboration BMJ 1994 ; 309 :1514-1515 (3 December)

Competing interests: No competing interests

25 September 2000
Bernard Guyot
consultant gynaecological surgeon
CHI Poissy ST Germain