Are medical professionals competent?

 Are medical professionals competent? Well? Are they?

Or are they just normal, incompetent human beings? (Surely some deep-seated, fundamental transformation happens when a person is handed a certificate with her name on it: she has graduated, stepped up and out of the domain of the incompetents, the hoi polloi... right? Isn't that how it works?)

I think it's pretty obvious that the answer to these questions (both of them) is, yes, no, and it depends.

I think the basic tendency of many?/most? (I don't know about numbers here) medical professionals, however, without being explicitly asked the question, is going to be basically, "Dammit Jim, of course, I'm competent -- I'm a medical professional!" 

But of course medical professionals are not as a group inherently all especially stupid people. And more especially, they're not all inherently incapable of self-knowledge. So when explicitly asked, I'm sure that they are mostly all perfectly capable of some simple reflection on the meaning of the question and on the reality of their own status as both medical professionals and human beings. And accordingly, if presented with the occasion to explicitly reflect on the question, I don't suppose that in general they're likely to have any special difficulty in arriving at a more nuanced answer than the initial straightforward "of course I'm competent!" 

Okay, so far, so what? 

We could of course say similar things about other professions, from engineers and scientists, to teachers and professors, to priests, lawyers, scribes, and pharisees. And we could even talk about people in the lowly so-called 'trades' -- although delusions of overarching competence is probably less of an occupational hazard in settings that require the very concrete no-nonsense kind of competence which is characteristic of the trades and which our society generally holds in less esteem than the so-called professions.

However, back to medical professions, since that's what I happen to be talking about. So when we say, "yes, medical professionals are competent -- but then again, maybe not, it depends," what distinctions do we need to make? 

Primarily, we're likely to be referring to their competence precisely as medical professionals. Insofar as they are required to have a foundation of education and training in their field in order to be professionally certified, obviously they must have some level of relevant competence here. But of course since they are human, with imperfect powers of memory and understanding, as well as occasionally unruly passions, as are those who trained them in the first place, and since the knowledge field wherein they are trained likewise is, and always will be, an imperfect work-in-progress -- at times more egregiously imperfect than at others! -- obviously even their competence as medical professionals, in the field of medicine, is limited. It is limited in ways inherent to human nature and to the nature of the medical profession, as well as in individual ways, based on the strengths and weaknesses, virtues and vices, of particular individual practitioners.

The evident variability involved in this kind of properly medical competence would seem to be a pretty straightforward thing, since the whole institution of medical training and certification is -- ostensibly and ideally, at least? -- directed towards trying to achieve and guarantee this kind of competence. That fact ensures at least that it's not likely an issue that will entirely fall off the radar.

But we should also note what this whole institution of medical training and certification is not directed towards: it's not directed towards any general competence in understanding the nature and limitations of medical competence. In other words, medical training, and professional training in general, is always and inherently directed towards a specific domain of competence, which is to say: a relatively limited and narrow range of competence. It is not directed towards a general understanding of the world, of society, of the full range of goods and values, and the proper place of medicine within that full range, that larger context. That kind of general understanding is just not what medical training is for. 

And similarly medical training is not directed towards giving the medical practitioner a sound general understanding of herself, whether as a human being in general, or as medical practitioner in particular, who has an important but certainly limited particular role to play -- commensurate with her particular important but narrow range of properly medical competence -- within the promotion of the general well-being of society. While it will always touch on and be related to broader issues, medical training is clearly directed towards a much more narrowly technical range of competence.

Now certainly I don't mean to say that medical professionals are always only narrowly competent, i.e., only competent insofar as they are medical professionals, as if for some reason being a medical professional makes it impossible to be also more generally competent, as a human being. In other words, it's not as if medical professionals can't, besides their medical expertise, also have a well-developed understanding of all of the interrelated aspects of human nature and the general well-being of society (a.k.a. the common good). It's just that as medical professionals, they have no special training and no special competence in understanding and assessing the bigger picture of what makes for human flourishing and of what needs to be done in any given complex situation in order to promote the goal of human flourishing.

The occasion for my offering this reflection is a recent on-line conversation I had with a medical professional. She made what I regard as some rather naive and formulaic pronouncements about covid-19 policies. But more interestingly she prefaced these pronouncements with the following captatio benevolentiae (i.e., a preface designed to capture the goodwill of one's audience -- this is a term from classical rhetoric, and just to be clear, I am using it ironically!): 

"I know this is post is getting stale but I just want to leave this here in case anyone (including OP) would like to look at this situation using science and logic, instead of just pure emotions. Please don't @ me unless you actually have some credible science/health care related background, as this is where this comment is coming from. I have to say this because we nurses have much more experience with communicable diseases than the average person. And feel free, if you're in healthcare, to correct me if needed."

Hmmm, yes. What to make of that? 

To begin with, no one had previously looked at the situation in question using "just pure emotions." To imagine that they even possibly could do so is, if you think about it, clearly just pure nonsense: it just literally doesn't even begin to make sense. So in the very act of claiming that she will examine the situation using science and logic, she fires off a silly and bald misrepresentation of the dialectical situation she is entering into, which in logical parlance is generally referred to as a straw man argument and is something which is precisely illogical to do. Later she also made some naive comments about ethics, so it's also worth pointing out that making straw man arguments is something that is also unethical (morally wrong) to do, since a straw man misrepresents the truth and such arguments certainly fall afoul of the basic principle of loving your neighbor as yourself and doing as you would be done by.

Secondly she also makes an obviously fallacious (i.e., not logical) appeal to authority. Her little preface is a silly and unethical attempt to intimidate and warn off most would-be interlocutors, that is, those who would dare presume to comment unfavorably on her authoritative pronouncements. Since one clearly doesn't need a specific background in the medical field to understand and discuss medical issues, this is clearly silly and dishonest. Consider: If you had to already understand medical knowledge before you were capable of intelligently and critically discussing it, then it wouldn't be possible for anyone to ever acquire medical knowledge so as to become a medical professional, because you would only be able to understand medical knowledge if you were already a medical professional. Fortunately that's not how learning and knowledge actually work. But hey, logic (and more particularly, epistemology)! It can be a tricky business, especially for the untutored and incautious. (Her argument here is on the level of "keep your rosaries off my ovaries" or "if you want the right to say anything about abortion, make sure you have a vagina and ovaries and stuff first" - and no, it doesn't matter if what you're saying is something that lots of women agree with and also say!)

So anyway, I think an important thing to notice and reflect on from this example is the conflation of medical competence with various more general competencies, in this case competence in logic and ethics and science -- not to mention public policy, which is what her analysis was actually about. 

(For the record, none of her post offered any special logical, scientific, or ethical insight. Neither did she offer even a single piece of specialized medical information that would have been news to any remotely with-it person, never mind connecting such information to anything remotely resembling a reasonable attempt to comprehensively evaluate the import of such information in relation to the overall picture of the common good. Instead her overall argument amounted to just, "listen to me, because we medical professionals are the ones who know -- but also don't dare question me (unless you're one of us), because..." Well it turns out she didn't really offer any answer there, just the evidently illogical and unscientific assurance that hers was the logical and scientific point of view in contradistinction to the purely emotional point of view.)

I don't want to make too much of this one person and this one example. But although I think it should be perfectly obvious, I think it would be helpful for a lot of people to reflect on the fact that a nurse may be highly competent as a nurse, and at the very same time highly incompetent in fields in which she has no special training, like logic, or ethics, or understanding the general nature and limits of science and of processes of scientific investigation and justification, or general public policy -- or even just being a decent and humble kind of person who at least makes a real effort to patiently and reasonably communicate with others, even those she rightly or wrongly deems to be beneath her.

If what I've just claimed about the compatibility of competence with incompetence is really so obvious, you might wonder, why bother about reflecting on it? It's because, as the example I mention shows, it evidently is not obvious to many people in their own concrete situations, and it only becomes obvious in virtue of taking some time to intentionally reflect on it. And that reflection on the competence as well as incompetence of medical professionals also has some rather obvious implications, which are also worth reflecting on, implications about how medical professionals worthy of the name ought to conduct themselves in conversation with non-medical professionals (e.g., be not a butthead, know thyself, recognize thy limitations!) and vice versa, for non-professionals talking to professionals (be not a butthead thyself, but also be not overawed by blustery medical professionals who fallaciously appeal to their own authority in matters wherein they may in fact prove to be at least as incompetent as the average Joe).