At some point in any medical career, certain things begin to feel familiar. You have seen enough cases that patterns appear more quickly. You know what you are looking for. You become more efficient, and you develop confidence in your judgment.
That is how experience is supposed to work. I would be concerned if I practiced medicine for years and approached every case with the same uncertainty I had during training.
But I think more about another side of experience now than I did earlier in my career. Familiarity can help you recognize what is in front of you, but it can also make it easier to assume that you already know what you are seeing.
In pathology, that distinction matters.
I have spent much of my career looking at tissue and making decisions based on patterns, details, clinical information, and what I have learned from previous cases. Experience has made me better at doing that. It has also made me more conscious of the cases that do not behave the way I expect.
The longer I practice medicine, the less interested I am in proving how quickly I can reach an answer. I am more interested in knowing when I should stop and ask another question.
Familiarity Is Useful Until It Becomes an Assumption
Pattern recognition is part of pathology. After years of looking at cases, you naturally develop a mental library. You remember what certain findings tend to look like. You learn which details are significant and which are less likely to change the interpretation.
There is nothing wrong with that. We need experience to make us more efficient.
The problem begins when recognition turns into expectation.
If I have seen something many times before, am I evaluating the case in front of me, or am I seeing what I expect to see? Is there a detail that does not belong? Would I notice it if I had already decided the answer?
Those are uncomfortable questions because physicians have to make decisions. We cannot approach every case as though nothing is knowable. Excessive doubt can become a problem in itself. Patients and clinical teams need useful information, not endless hesitation.
The goal, at least for me, is not to become less confident. It is to become more deliberate about where I place that confidence.
Unusual Cases Have a Way of Correcting You
Some of the cases that have stayed with me professionally are the ones that did not fit neatly into a familiar category.
My scholarly work has included unusual pathology findings, including an acantholytic variant of metaplastic squamous cell carcinoma of the breast and a case involving metastatic breast carcinoma identified within an endometrial polyp. These are not findings that define an ordinary day in pathology. That is part of what makes them educational.
An unusual case interrupts your routine.
You may begin with an impression that seems reasonable. Then a feature bothers you. Maybe the pattern is slightly different from what you would expect. Maybe the clinical history creates a question. Maybe one piece of the case simply does not fit comfortably with the others.
What do you do with that?
Sometimes the answer is that the unusual detail does not change the larger conclusion. Sometimes it does. The important part is being curious enough to investigate the difference rather than forcing it into the answer you already had in mind.
I do not think curiosity means treating every case as a mystery. Most medical work would become painfully inefficient if we did that. Curiosity is more selective. Experience should help us recognize which inconsistencies deserve our attention.
I Still Read Because I Still Encounter Things I Don’t Know
I regularly read breast pathology literature, including journals and new editions of textbooks. I also attend continuing medical education programs.
I have been doing this work for years. Why keep returning to books and journals?
The simple answer is that medicine changes. The more personal answer is that medicine keeps reminding you how much there is to know.
I understand some subjects far better today than I did during residency or fellowship. At the same time, greater knowledge has made me more aware of the edges of what I know. You discover another variation of a disease. A new study challenges an older assumption. A case sends you back to the literature because something about it is unfamiliar.
Any profession tempts you to see education as something that happens at the beginning. You train, qualify, accumulate experience, and eventually become the person who is supposed to know.
Medicine doesn’t cooperate well with that idea.
You can become highly experienced and still encounter something that makes you open a textbook.
I think that is healthy.
Teaching Has Made Me Question What I Know
Teaching medical students and resident physicians has reinforced this in another way.
When you have done something for a long time, parts of your reasoning become automatic. You see a pattern and understand its significance without consciously walking yourself through every step.
Then a student asks, “Why?”
Occasionally, the answer comes easily. Other times, the question makes you realize that you have not explained the reasoning to yourself in quite a while.
Teaching forces you to take knowledge that has become instinctive and make it explicit again. Why does this finding matter? Why would I favor one interpretation over another? What would make me change my mind?
I benefited from that kind of teaching myself. Dr. Jonathan Lara and Dr. Ira Bleiweiss were important mentors in my development in breast pathology. Experienced physicians can teach facts, but I found more value in learning how experienced people approached problems.
Years later, I appreciate how difficult that kind of judgment is to teach.
Experience Should Change the Questions
I do not believe experience should make physicians suspicious of everything they know. There has to be a balance.
If I second-guessed every observation simply for the sake of second-guessing it, I would not be practicing better medicine. Experience exists for a reason. It gives us a foundation for making decisions.
What I want to avoid is allowing that foundation to become a boundary.
Earlier in a career, curiosity often comes naturally because so much is unfamiliar. You ask questions because you know you are learning. Later, you have to maintain that curiosity more intentionally. You have to stay willing to notice what doesn’t fit, read about something you haven’t encountered before, or reconsider an impression when new information changes the picture.
I once thought expertise would mostly mean having more answers.
After years in medicine, I think it also means having better questions.
The experience still matters. In fact, it matters enormously. But perhaps one of the best things experience can give a physician is the ability to recognize when familiarity is useful and when curiosity needs to take over.