Dunning-Kruger? I barely know 'er!
The curse of a medium-amount of knowledge
Sometimes I come across something I wrote 10 years ago and cringe. That’s pretty normal, right? I assume that we all look back on diaries, emails, facebook status updates and think ‘Oh god was I really that insufferable…?’ But, unfortunately for me, my ramblings were published online and (mostly) still exist for all to see. Thankfully I archived my very emo Livejournal diary and the Talonted Lex website’s main focus was sharing rosacea advice, make up recommendations, and nail art tips, so I escaped pretty unscathed in the humiliation category. But - as you would expect - some of the information I shared back then does not hold up to scrutiny.
If I was being generous to myself, I would say that I was learning in public - about rosacea, about my skin, about myself. I was open about my lack of medical training, about my losses as well as my wins, I encouraged everyone to discover and learn alongside me. But I definitely had the misplaced confidence of someone who is just starting to learn about something and can’t wait to share it. I spoke in absolutes, repeated claims I read in PR emails without much critical thought, and applied my personal experiences to every situation.
This is a perfect demonstration of the Dunning-Kruger effect. If you haven’t heard of it, it’s described as “a cognitive bias in which people with limited competence in a particular domain overestimate their abilities.”
Yep, that sounds familiar.
I started off knowing nothing about rosacea and then, in a relatively short space of time, I read and experienced a lot which made me believe that I was an expert. I didn’t know what I didn’t know, and acted accordingly. It was only as I gathered more information and more experience and met more people who helped to educate me and broaden my mindset that I began to realise how much I still didn’t know. It was a very steep slide down that curve.
“Ignorance more frequently begets confidence than does knowledge” - Charles Darwin
I spent last week trying to push through feelings of imposter syndrome to finish writing a blog post I’ve been planning for ages. I have a list of very common rosacea questions I often receive, and the goal is to eventually have each one answered in a post so that my website can help people find the answer to literally any rosacea question they might have. A big one was ‘what’s the difference between a flare up, flushing, and blushing?’
When I wrote out the title, I genuinely thought it would be a 250 word post I could knock out in an hour and be on my merry way. Cut to me, 10 days later, labouring over a 1500 word post (still unfinished). As I began writing, I realised that I wasn’t entirely sure of the technical mechanisms that makes a regular person’s face flush, let alone why a person with rosacea might flush more easily. This led me to research the physiology of the skin and blood vessels, as well as confirming what I knew about the etiology of rosacea.
But, because I’m not a dermatologist, I had to read a lot of sources to make sure I understood what I was talking about, then I had to try to work out how to explain this complicated information in a way that made it accessible to anyone reading it. But the more articles I read, the worse I felt and the closer I came to just deleting the whole thing, which is why it’s still sitting in my drafts folder, gathering proverbial dust.
The internet is filled with people who know a tiny amount about a topic but who still take up space, accumulate followers, and gain trust simply because of their vast social media presence. Some of them even get invited to speak to US Congress as experts. It’s impossible to scroll TikTok without seeing an uninformed but loud opinion on anything from vaccines, to seed oils, to sunscreen, to parenting, to mental health. The comment sections are filled with support from those with even less knowledge, but who are along for the ride because the topic confirms their existing bias. It doesn’t help that the response videos from experts tend to be much longer, require a bit more time and critical thinking from viewers, and - let’s be honest - just aren’t very sexy. Snappy soundbites and wild-eyed fearmongering will always travel further than sensible explanations and robust sources.
But is there a place online for a middle ground?
I’ve started thinking of myself as an expert-novice. I have no medical training and would never claim or imply that I do. My knowledge comes from my own experience as well as the accumulated knowledge of speaking to hundreds of thousands of rosaceans over the past decade. I run a private Facebook group (you can join here if that’s your thing!) where people ask questions, share concerns, and recommend anything and everything they feel has helped. I receive emails, DMs, and comments every day that make me see things from other perspectives. I’ve probably read and written more about rosacea than most GPs. I’m very aware that that statement gives big Dunning-Kruger vibes, but unfortunately that’s not hyperbole. When GPs are training, they get 5-10 days of training on skin conditions. All of them. So it’s not surprising that I’ve heard countless stories about GPs repeating myths that have long been discredited - “you’re too young for it to be rosacea”, “it can’t be rosacea because you’re not white”, “there’s no cure so there’s nothing to be done”. (All of these are bullshit, just so you know!)
But I am still hugely aware of the gaps in my knowledge. Most of my blog posts start with a disclaimer explaining my history and lack of formal training. I’m not embarrassed of my ignorance, I’m actually pretty proud of the fact that everything I know about rosacea I have taught myself and worked really hard to gather. Over the years I have interviewed experts and leaders in so many fields to attempt to plug the myriad gaps in my knowledge. Among others, I’ve spoken to Consultant Dermatologists about laser treatments, Plastic Surgeons about rhinophyma, Nutritionists about the role of the diet, Consultant Ophthalmologists about ocular rosacea, Psychodermatologists about neurogenic rosacea, and facialists about non-medical treatments for rosacea.
I also want to shout out the experts who acknowledge the gaps in their knowledge. The amount of medical experts who I’ve spoken to who have admitted that, yes they know a lot about rosacea and how it works, the medications, etc. but they have zero concept of how it feels, how it affects a person, how it can derail your life. Those people acknowledge that rosacea is so much more than a skin condition and it needs more nuanced support than a prescription and a lecture on trigger management. Some of them have even told me that they recommend my website and social media to patients so that they can find support, share the burden, and access information within the community.
I think this blend of medical and community support is really useful and is something that was lacking when I was first diagnosed. But as internet users, how do we navigate the volume (in both amount and loudness) of the misinformation? The grifters who put greed before care? Or the people with good intentions who might still be doing harm? How does the average person online know if a creator is shouting from the top of that confident-but-ignorant bell curve, or languishing at the bottom, or strapping on their figurative crampons and battling up that hill heading for the other side?
If Lex from 10 years ago could read this, I’m sure she’d be shocked. The amount of information and experience we’ve gathered in a decade and we are still wondering where we fit in this space and wonder how we can continue to help others?! My journal scribblings recently have all been along a similar theme: Is my content still useful? Do I need to evolve? Am I a millennial dinosaur live-blogging the approaching meteor? Am I doing enough to reach people where they are? Is there a better way to share rosacea information? Maybe the fact I’m asking these questions and my ongoing concern about this topic is a good sign. A sign that my Expert-Novice voice is a necessary one in this space. Afterall, if I didn’t care, I wouldn’t still be here.
I started this Substack so I could talk more personally about the issues that interest, affect, fascinate, or concern me. So here I am being honest with you about the way I’m currently feeling about the online space. Sometimes - like right now - pitting ‘care’ against ‘greed’ can feel like bringing a knife to a gunfight.
Your last sentence- “pitting ‘care’ against ‘greed’ can feel like bringing a knife to a gunfight” rings so TRUE but that’s why those who have the ability to show up are so important and appreciated by those of us on the sidelines. Rooting for you Lex and so appreciate that you are in this space.
I really appreciate what you do Lex. As someone who at some points in the last 3 - 4 years has gone down a wellness rabbit hole, come back to your writing because I think it's grounded in reality. It's quite interesting to watch some of those who I consider grifters as their advice seems to change with the seasons and then it all boils down to "oh but you're not trying hard enough". From you I get the real sense of your own experience & thoughtfulness around rosacea as this piece confirms. Thank you!