The Paradox of Clinical Expertise

Why the more clinicians know, the harder it becomes to communicate with patients

By C. Anthony Jones

In medicine, expertise saves lives. But it also creates a blind spot.
The deeper a clinician’s knowledge, the harder it becomes to imagine not knowing. That’s the paradox: the very mastery required to deliver excellent care can make it nearly impossible to communicate that care clearly to the people who need it most.

Expertise rewires how you think—and speak
One of my attending physicians said something I never forgot: “In medicine, you spend your career learning more and more about less and less.”

The deeper you go in a specialty, the more your thinking—and communication—gets shaped by that depth.

Years of training in an increasingly narrow field rewires how information is processed. Medicine stops being a language and becomes a reflex. Acronyms replace explanations. The difference between probability and possibility is deeply understood (if not always clearly communicated). Protocols become muscle memory. What once required careful thought becomes instinct.

But for patients, none of that exists.

They don’t think in differential diagnoses. They don’t distinguish side effects from adverse events. They hear, “You may experience some discomfort” and assume a dull ache—until the anesthesia wears off and they’re curled up in agony, wondering what went wrong.

You can’t “unknow” what you know
This isn’t about empathy. It’s about cognition.

Psychologists call it the “curse of knowledge”. Once you know something, it becomes incredibly difficult to imagine what it’s like not to know it. One study found that experts consistently overestimate how well others will understand their explanations—by a wide margin(1).

That’s a problem when you're talking to patients, many of whom are hearing these terms, instructions, and risks for the first time.

A systematic review in BMJ Quality & Safety found that 40% to 80% of medical information is forgotten immediately after it’s delivered—and nearly half of what’s remembered is wrong(2). It's not because patients aren't trying—it's because the system assumes understanding instead of ensuring it.

This isn’t a bedside manner problem
We’ve all encountered clinicians who could improve their bedside manner—or who simply lack the emotional intelligence to connect on a human level. But this goes far beyond listening skills.

This is a design problem. A systems problem. And it’s getting worse, not better.

When the entire care experience is built around expert workflows, expert language, and expert pacing, patients fall through the cracks—not because they’re “non-compliant,” but because they were never truly on the same page to begin with.

And the one thing that might help? Time.
Sadly, the system has stripped that away too.

If we want better outcomes, we need better translation
That starts by recognizing that patient understanding isn’t a given—it’s a goal.

It means rethinking how we deliver instructions, how we check for actual understanding vs. the ubiquitous head nod, and how we support patients in the days and weeks after they leave the clinic. Not by dumbing things down—but by structuring guidance the way patients actually process and act on information: clearly, incrementally, and in context.

Because no amount of clinical brilliance matters if the patient can’t follow the plan.

Sources:
1. Hinds, P. J. (1999). The curse of expertise: The effects of expertise and debiasing methods on prediction of novice performance. Journal of Experimental Psychology: Applied, 5(2), 205–221.

2. Kessels, R. P. C. (2003). Patients' memory for medical information. Journal of the Royal Society of Medicine, 96(5), 219–222.