For Doctors, the World Is Too Big to Know

Posted May 30, 2012

By Bryan Vartabedian, MD

I recently read Too Big to Know by David Weinberger. Times have changed. We used to get information from books or experts. But now knowledge is on the network. Patients have access to the same information as doctors. Everything we understand about knowledge, where it lives, and how it’s shared is changing. Too Big to Know occupies itself with the fact that the smartest person in the room is the room itself.

This is an important book with respect to understanding our evolving relationship with information.

I was intrigued by Weinberger’s concept of “stopping points.”  He describes stopping points as our historic way of packaging and processing large amounts of information.  These are authority-defined, rationed pieces of knowledge and information that we can get our hands around.  Basic science curricula, books, reports, and libraries are stopping points.

While Weinberger concedes that we need stopping points, the concept reflects the fact that the network of knowledge is changing the nature of knowledge and how we see it.  “Knowledge now is the unshaped web of connections within which expressions of ideas live.”

Our system of knowledge is a clever adaptation to the fact that our environment is too big to be known by any one person. A species that gets answers and can then stop asking is able to free itself for new inquiries. It will build pyramids and eventually large hadron colliders and Oreos. This strategy is perfectly adapted to paper-based knowledge. Books are designed to contain all the information required to stop inquiries within the book’s topic. But now that our medium can handle far more ideas and information, and now that it is a connective medium (ideas to ideas, people to ideas, people to people), our strategy is changing. And that is changing the very shape of knowledge.

Consider how this applies to medical education.  Despite the explosion of medical knowledge, we continue to find a way to fit what young doctors need to know about basic science into 24 months.  It’s our way of believing as educators that we can contain and process what’s happening around us.  It’s our stopping point.

Our system of medical education is founded on the belief that we can teach young physicians what they need to know.  This belief comes from generations spent with medical knowledge that was conveniently sized to fit between the covers of a textbook.  But knowledge may no longer be something that can be mastered or harnessed, but rather something that is accessed.

And all this has me wondering: How should accessible network information be balanced with that committed to memory? How will the doctor of 2050 process and apply information appearing faster than any traditional authority can conceptualize?   I suspect that we have little choice but to initiate the move from here’s what you need to know to here’s how you access what you need to know.  Here’s how the borderless network of knowledge and expertise should integrate with your workflow.

Everything we understand about knowledge is changing.  And operating within our 20th century construct of expertise, all of this is really hard to grasp.

People study hard and become experts in particular areas. They earn credentials—degrees, publications, the occasional Nobel Prize—that make it easier for us trust them. They write books, teach classes, and go on TV, so that we all can benefit from their hard work. The results of that work go through vetting processes appropriate to the type and importance of its claims, providing us with even more assurance of its accuracy. As new discoveries are made and sanctioned, the body of knowledge grows. We build on it, engaging in a multi-generational project that, albeit with occasional missteps, leads us further along in our understanding of the world. Knowledge is a treasure, knowing is the distinctively human activity, and our system of knowledge is the basis for the hope that we might all one day come to agreement and live in peace. We’ve grown up thinking that this is how knowledge works. But as the digital age is revealing, that’s how knowledge worked when its medium was paper. Transform the medium by which we develop, preserve, and communicate knowledge, and we transform knowledge.

Too Big to Know is an important book and has major implications for medical education.  We should talk and work to figure out how stopping points and our shifting understanding of knowledge applies to the next generation of doctors.  Because for the the first time in history, there’s just too much for a doctor to know.

–Bryan Vartabedian, MD, is a pediatric gastroenterologist at Texas Children’s Hospital/Baylor College of Medicine. He blogs at