Wisdom and knowledge


Category : Medical Rants

We live in a different age of information in 2012.  Students and residents regularly access information during rounds, to the benefit of patients.  During my rounds, I often stop to ask someone to look up an idea.

Yet our testing still focuses on knowledge.  In reading the book Practical Wisdom, I have learned that while we can access less knowledge as we get older, we actually have more wisdom, that is that we use information more wisely.  Our judgment improves while our knowledge decreases.

I believe we have a paradox.  We judge intern applicants using knowledge based tests.  We use the same types of tests for maintenance of certification.  But judgment trumps knowledge.

Here is the problem.  Our paper-and-pencil test, our computer tests, give us information.  But a great part of wisdom is information acquisition.  How do we test history taking and physical exam skills?  How do we measure the ability to read body language, develop relationships with patients, gain their trust and therefore get the history correct?

Wisdom involves experience.  It involves illness scripts developed with great granularity.  It involves knowing when we can trust ourselves and when we need assistance.

Our students and residents understand that they can read knowledge in a book, but they need us to role model how to use knowledge and information to make excellent decisions. 

That is the problem with tests and performance measures.  Their measures are incomplete.  But the testers do not understand.  The live in Flatland while we live in a 3-dimensional land. 

We certainly need knowledge, but any experienced attending physician will tell you that knowledge alone requires experience to achieve wisdom.   Just observe the difference between interns and 3rd year residents.  The residents do slightly better on the test, but dramatically better in patient care.

Understanding the importance of wisdom is something that our leaders should address.  Our patients deserve wise physicians not just smart physicians.

Comments (3)

"Data are not facts,
Facts are not information,
Information is not truth,
Truth is not knowledge,
Knowledge is not wisdom."
Critical Care Med 2000 28 (8): 3050-3052

Who said that the only thig being tested is knowledge? What about dedication? The exams are not very difficult in medical school. The people who do bad dont want to make the sacrifices to do better. When you get a guy with a 270 step and all honors you know he's going to work hard (not to say the others won't). I don't see go you test wisdom and if it's from experience I don't see how that would be fair anyway.

[…] recurrent theme in this blog is the difference between wisdom and knowledge. I wrote 3 years […]

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