• paediatrics
• child health

You might know that I’m a generalist, and a fairly noisy one at that. When asked what I specialise in, I reply ‘I specialise in not specialising’. Of course, on quite a few levels that’s absolute nonsense. After all, like most people reading this I’ve made a point in specialising in paediatrics and child health. And it is inevitable that I’ve actively forgotten many of the things that I’ve learnt over the years. Is active forgetting an important part of specialisation? I certainly feel the need to jettison some of the less actively useful information in my head to focus on some items which are more helpful for the task at hand.

Arguably this is a generalist journal—although a generalist paediatric journal. I’d hope that there is a lot in here for folk who have decided to focus their interests—but that it will mostly include articles which, hopefully, are helpful to the majority of us. This issue has, for example, a great paper which might enlighten someone who is about to be part of a clinic for children with Down Syndrome for the first time. Written by Rebecca Dalrymple, Laura Helen Somerville, Sherin Hamza and Nashwa Matta, it is this month’s editor’s choice ( see page 88 ). The question becomes: If I read this (excellent) paper, will I be useful in the clinic? At the one extreme, we should, I think, have a broad base to our specialist skills in paediatrics and child health, so that we can apply these to a specific, more specialist situation. After reading this article, someone who has some expertise in children’s healthcare should be able to make a good attempt at such a clinic. At the same time, it is probably a mistake to conclude that expertise is easily won. Two years experience of a pandemic, watching people draw very wrong conclusions from their own reading of data has certainly highlighted this.

Our learning is layered. We want our patients looked after by the best healthcare professionals that we can be, which means tempering our expertise with humility, but also having confidence that we’re going to be, fundamentally, all right. I’m struck here with a series of quotes, all of which are worth reflecting on.

The first was frequently said to me by the late Peter Daish when I was his SHO, but the internet tells me it originated from someone called Michael O’Donnell: ‘Experience is making the same mistakes with more confidence.’ This is important to take me down a peg or three.

The second is a quote which seems to have been ascribed to nearly everyone, depending on your internet search: ‘Make things as simple as possible, but no simpler’. Which is part of the function of writing in this journal—and the challenge of editing it too.

The last is one from Robert Heinlien, which he put into the mouth—or diary—of his apparently immortal character Lazarus Long in Time Enough For Love: ‘A human being should be able to change a diaper, plan an invasion, butcher a hog, conn a ship, design a building, write a sonnet, balance accounts, build a wall, set a bone, comfort the dying, take orders, give orders, cooperate, act alone, solve equations, analyse a new problem, pitch manure, programme a computer, cook a tasty meal, fight efficiently, die gallantly. Specialisation is for insects.’

Thinking about these, and especially the last in the context of the many centuries it took Lazarus Long to acquire these diverse skills, I’m struck that we need to feel comfort about segueing into some degree of expertise at many points in our lives, while being completely open to criticism that we may have that expertise completely wrong.

If you want to keep up with your general learning, I’d remind you to subscribe to alerts in whatever manner suits you for the journal. It’s really easy to do—just go to ep.bmj.com and at the bottom of the page you’ll see the instructions.