Blog | Monday, March 30, 2020

Lessons from 'Range' by David Epstein

I received an email from Ryan Holiday – author of The Obstacle is the Way, a wonderful book that introduced me to Stoic philosophy as a guiding principle. In that email, he recommended ”Range: Why Generalists Triumph in a Specialized World” by David Epstein. As a generalist, the title intrigued me. So as I am prone to do, I bought the Audible version, and over a 10 day period, listened to the book.

Like many books in this genre, one can criticize the trees of his argument, but I think he gets the forest right. This website has a collection of reviews, many of which are somewhat critical. Nonetheless, I found that his stories helped me understand much of my personal success and happiness with my career.

The book has several major points. He makes a reasoned argument that for complex careers (be it sports, arts, business or medicine) one benefits from starting with breadth. Unless one is working towards expertise in a “kind problem” (examples, chess and golf), then a variety of experiences allows one to discover where they want to specialize. Often early specialization fails because as we grow, we too often find that the early specialization ignores the most important success attribute – finding ones passion.

As I think of my career, I “flirted” with many majors in college prior to settling on psychology. Then for the first 2.5 years of medical school I again dated several specialties. After a week on the internal medicine rotation, I knew that I had found my home, my passion and my career.

Yet once I chose internal medicine, I once again considered a variety of subspecialties. I even did a year of basic science nephrology fellowship, and had the courage to quit, as I missed patient care and teaching too much. The research did not give me the same satisfaction.

Epstein devotes significant time in the book to the value of leaving certain situations. I left a fellowship and joined a new division of general internal medicine. Originally, I had considered finishing a clinical fellowship, but general internal medicine grabbed me as a great choice. I actually like most subspecialties in internal medicine. The complexity of managing multiple problems satisfies my love of puzzle solving and mystery novels.

Epstein worries that overspecialization makes it more difficult to solve many complex problems. He argues that breadth of background allows us to make intellectual connections that overspecialization makes less likely.

Now I must admit that the idea of this book and the many examples likely appeals to me because of confirmation bias. One look at my CV shows that I do have some recurring themes, but also a great variety of articles. Many articles started with thinking about a problem in a different way thanks to varied experiences.

He is a storyteller. I suspect he has found stories that fit his general hypothesis, but since I like his hypothesis, it does not bother me.

Regardless, this book will stimulate your thoughts about expertise, the advantages of generalization and the advantages of specialization. As a clinician-educator, reading books like this eventually help me and give me insights into the education process. Perhaps that is the most important message of the book. We should not restrict our learning to our specialty. We should learn from other fields. This book makes my top list of non-medical books for junior academicians.

For those interested:
1. Made to Stick – Chip and Dan Heath
2. First, Break All the Rules – Marcus Buckingham
3. 7 Habits of Highly Effective People – Stephen Covey
4. The Elements of Style – Stunk & White
5. Drive – Daniel Pink
6. The Obstacle is the Way – Ryan Holiday
7. The Tipping Point – Malcolm Gladwell
8. Sources of Power – Gary Klein
9. Originals – Adam Grant
10. Thinking, Fast and Slow – Daniel Kahneman
11. Range – David Epstein

db is the nickname for Robert M. Centor, MD, MACP. db stands both for Dr. Bob and da boss. He is an academic general internist at the University of Alabama School of Medicine, and the former Regional Dean for the Huntsville Regional Medical Campus of UASOM. He still makes inpatient rounds regularly at the Birmingham VA and Huntsville Hospital. His current titles are Professor-Emeritus and Chair-Emeritus of the ACP Board of Regents. This post originally appeared at his blog, db's Medical Rants.