There is a particular confidence that comes from having done the thing yourself. Not read about it. Not watched someone else do it. Not quoted a paper that quotes another paper. But actually stood there, hands involved, making decisions in real time, feeling the resistance of tissue, the unpredictability of physiology, and the weight of consequence that no journal article can fully capture.
That is where true expertise comes from.
In trauma especially, knowledge that has not passed through your hands is incomplete. You can understand principles, memorise algorithms, and recite outcomes, but until you have performed the intervention yourself, you do not truly know its benefits, its limitations, or its traps.
And it is the traps that matter.
Doing the Work Teaches You What the Literature Cannot
Procedures and interventions look wonderfully clean in publications. They appear linear, controlled, and reproducible. Complications are summarised neatly at the end, often reduced to percentages and confidence intervals.
Reality is messier.
When you perform an intervention yourself, you learn where it becomes awkward. You learn which step feels simple in theory but is treacherous in practice. You learn what happens when the anatomy is distorted, the patient unstable, the lighting poor, and the clock unforgiving.
You learn what works when everything goes well.
But more importantly, you learn what happens when it does not.
That knowledge cannot be borrowed. It has to be lived.
The Difference Between Knowing Of Something and Knowing It
There is a subtle but important distinction between knowing of a technique and knowing it deeply. The former allows you to talk confidently. The latter forces humility.
Those who have done the work themselves speak differently. They qualify their statements. They hesitate before making absolute claims. They understand that every intervention carries trade-offs that cannot be fully predicted from a distance.
Those who have not done it often sound certain.
And certainty, in trauma, should always raise a quiet internal alarm.
Be Wary of the Expert Who Only Quotes Others
This is where caution is needed.
Medicine, and trauma in particular, has a recurring phenomenon: individuals who speak fluently about interventions they rarely, if ever, perform. They quote guidelines, cite studies, reference consensus statements, and speak with an authority that is not grounded in lived experience.
They are not dishonest. But they are incomplete.
Quoting the work of others is necessary. It is part of scholarship. But when it becomes a substitute for practice rather than a complement to it, something is lost. Advice becomes abstract. Recommendations drift away from reality. Nuance disappears.
In trauma, that disconnect matters.
Why This Matters for Patients and Trainees
Patients deserve care guided by people who understand not just what should be done, but what it actually feels like to do it. Trainees deserve mentors who can say, honestly, “I have done this, and this is where it can go wrong.”
There is a difference between teaching technique and teaching judgement. Judgement only comes from experience.
When we elevate voices that are distant from practice, we risk creating systems and expectations that look impressive on paper but fracture under pressure.
A Quiet Standard Worth Defending
This is not an argument against research, evidence, or collaboration. It is an argument for balance. The strongest clinicians are those who combine scholarship with practice, theory with touch, and evidence with experience.
They read widely.
They reflect deeply.
And they still put their hands on patients.
Expertise, in the end, is not declared. It is recognised, quietly, by those who know the difference.
And if there is one principle worth holding onto in trauma, it is this:
Be guided by those who have stood where you stand, felt what you will feel, and learned the hard lessons not just from the page, but from the patient.
That kind of expertise is not loud.
But it endures.
