“It’s so easy to start your career in health thinking that you’re a legend in your own mind. Actually, without knowing this one thing, you are pretty well destined to start your career there. And even if you know this one thing, you might want to deny it anyway!!

So let’s get on to what this “one thing” is so that we can move on from it and figure out where we really need to be as practitioners……

And no, I’m not going to apologise for the fact that the image below isn’t entirely in English, because I’m much better off spending my time explaining it than I am drawing a new one…… (my graphic design skills are woeful at best).

If you haven’t heard of the Dunning-Kruger Effect, please, let me assist you in getting acquainted!

The “iskustvo” along the x-axis is experience, and the “osecaj kimpetentnosti” on the y-axis is the feeling of self-perceived competence. You have probably figured out that as you go further to the right along the x-axis you become more of an “ekspert.” That is, an expert as your knowledge in your field increases. As an addition to the image from Wikipedia Commons, I have added in a blue arrow, which points to a place that I have heard people in lectures call “the top of Mount Stupid.”

So Mount Stupid is this place where we apparently find ourselves when we graduate, in my case, as an optometrist. I remember being a new graduate thinking that I must know everything, because, why else would a university award me with a degree, right?

But then, as anyone who has practised as a health professional would know, something happens to knock us off the top of Mount Stupid. It’s the patient who comes in with vague symptoms who you aren’t quite sure what to do with, the clinical examination you do which you find to be confusing because you’re not sure if the diagnosis is say allergy or infection because there can be times when they look quite similar.

If you’re anything like me, you then spend years questioning what on earth is going on. Your confidence in your ability drops as you are becoming more experienced and you think you get things wrong in the clinic. But the reality is that yep, we all get things wrong. None of us are perfect! For me I think it’s about how you respond when you get something wrong, but that is beyond the scope of this article. Let’s stick to the topic at hand……

So then some time goes by, we learn where our weaknesses are, and hopefully actively seek the knowledge we have become aware that we lack. After some time of going through this, we become the expert that we thought we were in the first place.

I couldn’t help but add in John Cleese’s take on the Dunning-Kruger effect as he puts it into words in a way that only he could!

John Cleese on the Dunning-Kruger Effect. Still the clearest description I’ve found: pic.twitter.com/HX92dYlHFD

— Eve Keneinan (@EveKeneinan) September 17, 2016

So while I think that the Dunning-Kruger effect is a massive reason why as primary health practitioners we can tend to think that we’re legends in our own mind, there is more than just that at play.

Say you’ve “been around” as a health practitioner for a while. You see patients who come in and complain about their previous practitioner and think “great – here’s an opportunity to impress them and make this patient loyal to me and this practice rather than those clowns down the road.” Maybe it even puffs up your ego and makes you believe that you are indeed better than your competitors. But have you ever stopped for a minute and thought about how many of your patients have gone to YOUR competitor and described YOU as the clown down the road?

Ouch!! Was that a bit difficult to swallow? Chances are that no, you’ve never really considered that. It took me a few years of practice to burst that bubble for myself! I wish someone had done it for me earlier though so I didn’t think I was so freaking fantastic early in my career when I actually wasn’t!

Consider the patient where you really did get something wrong. How many of them will actually come back to you and complain? To give a personal example, I changed GPs about a year ago as I had been experiencing physical symptoms for a number of years that my regular GP had kept telling me were normal. Being the trusting health professional that I am (or was….), I didn’t ever Google my symptoms during that time because I thought that my previous GP seemed to be fairly knowledgeable and on the whole, had things under control. It wasn’t until my physical symptoms were “undeniable” that I went elsewhere. To cut a long story short, under treatment with my new GP it has taken a whole year to get my health anywhere close to okay, and it is going to take a while longer yet until I’m completely back on track. Did I bother to go back to my previous GP who had mismanaged me for 15 years? No. Did I get really annoyed? Of course! Did I feel that it was a productive use of my time (and the Medicare rebate attached to seeing my old GP) to front up there really just to have a go at her? No.

The point I’m making here is that if your patients are anything like me, they have better things to do than come in and berate you if you’ve stuffed up. They would just rather move onto someone else who is able to manage their health. So yep, you may have absolutely stuffed up someone’s care for years on end, and then you don’t see them ever again. But if you don’t realise that you’ve stuffed up in the first place, perhaps you just figure that those patients moved town or city, as my old GP knew I had. Why would you have any reason to doubt your “legend practitioner” status?

So why else might we think we’re legends in our own mind as primary health practitioners? I think a big part of it is the job we do. Many of us are in a situation where a lot of people will seek care for common conditions. After all, as a specialist I sat in with recently said “common conditions are common.” But obviously we need to be on the lookout for the nasty but uncommon conditions too.

The thing about some of these nasty but uncommon conditions is that there may be only very subtle signs early on in the disease process. And the symptoms may not be present at all because the condition is asymptomatic, or not noticed by the patient because they are not bothered at all. I’m sure that any of us who have been around for a while have missed these nasty but uncommon conditions because we were focused on the patient’s primary issue (not that it’s a bad thing to focus on the patient’s presenting issue!!).

But the point I’m making is that we probably miss things all the time, and are blissfully unaware. This is another reason why it’s so easy to think we’re legends in our own mind. In primary care, it might be years before that patient ever runs into real issues because of their nasty, uncommon condition, and I doubt by that time that they will even think to blame you for not picking it up years earlier, especially if they have gone to see another practitioner. I mean, in surgery or an emergency department it’s pretty obvious if someone dies during treatment due to an error. But in a disease process that is subtle in the early stages, under what circumstances is that going to come back to haunt you?

So now that any new graduate, or perhaps even experienced health professional reading this is perhaps a little paranoid, stay tuned for my next article at the end of “graduate fortnight.” It will be published on the 15th September. It’s about sticking to your guns. I will be sharing a story where I didn’t stick to my guns and it almost cost the patient their sight, if not potentially their life……”

Amanda Griffiths is the founder of My Health Career. Since starting the website she has been an invited speaker for organisations including the Career Development Association of Australia and Career Education Association of Victoria, myfuture, and the Master of Ceremonies at the HealthFusion Team Challenge. She graduated from her optometry degree with first class honours in 2003, and spent two years as a part-time clinical supervisor of optometry students in a university setting. Amanda has worked as an optometrist in full time, part time and locum roles that have stretched from far north Queensland to Tasmania.

More articles on My Health Career:

• Professionalism in an age of shifting expectations – by Amanda Griffiths
• The 10 commandments of patient-centred care
• Can optometrists please agree that we will be wary of these 5 things? By Amanda Griffiths

Image: Wikipedia Commons