Emilie Couchman is a generalist bridging clinical care, research, teaching and publishing at University of Leeds, Division of Primary Care, Palliative Care & Preventive Medicine
Donna Wakefield is a palliative medicine consultant currently undertaking a mixed methods PhD at University of Leeds, Division of Primary Care, Palliative Care & Preventive Medicine
‘Dual expertise’ describes the intersection of personal experience and professional knowledge. Co-production has traditionally been framed as the collaboration that occurs between people with lived experience and professionals.1 This binary perspective, segregating lived experience and academic or clinical expertise, limits our ability to recognise and make use of ‘dual expertise’. What about researchers and clinicians who have lived experience? How can we demonstrate that each component of one’s identity doesn’t compromise the validity of another?
We are advocating for a shift in how we understand and value the knowledge that people bring.
The notion of dual expertise is undoubtedly a little messier than a neatly-defined binary team involving ‘lay persons’ and ‘professionals’. People naturally prefer simplicity over complexity. The ‘clinical academic’ is a tangible example of how a system can become confused by people with a multi-faceted professional identity. Despite there being a defined and integrated clinical academic pathway, there is much variation in how such roles are defined, understood, and accepted. This creates inequity in opportunity and experience among clinical academics. They should be recognised as being greater than the sum of their parts, rather than far-too-busy individuals who are doing a half-a-job at each ‘separate’ component of their role. There may well be ‘clinical’ academics who have not worked clinically for decades, but their previous clinical experience is still valued. Despite this parallel example, having a clinical or academic role can be seen to overshadow an individual’s knowledge gained from personal experience.
It is clear that stigma hinders the expression of personal experience in the professional context, with some fearing critique on their professional ability. Let us then consider the palliative and end of life care context. Everyone dies. Clinicians in this field are therefore highly likely to have experienced loss in their personal lives and have clinical and academic experience of death and dying. Further, people tend to pursue professional interests sparked by personal experience, making dual expertise even more likely in this context.
Of course one can argue that there is a risk that dual expertise researchers may be used as a way to save money. For instance: “We don’t need to establish a PPI group for this study. Professor X’s mother died of this condition last year, we can just use him.” We are being flippant, but one can see how this issue could be manipulated if intentions are not good.
We recently submitted a grant application that illustrates the fact that there is still a hill to climb before dual expertise is fully accepted and valued. The proposed Patient and Public Involvement and Engagement (PPIE) co-lead of the project is a palliative medicine consultant, which has raised some eyebrows. This individual has personal experience of supporting a family member with the rare cancer at the centre of the study through illness and death; conducts high-quality research in this field; provides palliative and end-of-life care to patients and their loved ones; and contributes to service design and provision at population-level. Who better equipped to add value? They also grapple with the friction that accompanies their dual (triple/quadruple…) expertise on a daily basis: ‘A patient said to me yesterday, “…you don’t know what it’s like to be human.” But I do.’2
We generally assume that a PPIE member must be a layperson.
We generally assume that a PPIE member must be a layperson. What do we mean by ‘layperson’? Is every PPIE member required to be someone who has never been in paid employment, or has never set foot in an educational institution? Of course not. If the point of research is to develop clinical interventions that ‘serve the needs of a general population without specialist understanding,’ the role of lay perspectives remains essential.3 However, some PPIE groups have ‘expert patients’ who have been on a multitude of PPIE panels for many years. In our respective fields, we might recognise the same names recurrently contributing to projects. Perhaps such PPIE colleagues can be considered professionals themselves.
We are advocating for a shift in how we understand and value the knowledge that people bring. In The Lancet Psychiatry, Gergel discusses the need to ‘harness the potential of such dual expertise’ in the context of mental health research. She suggests thinking of dual expertise in a way that appreciates that the sum of the parts are greater than their individual contribution, enriching research and clinical practice in ways that neither perspective can achieve alone. She also highlights that the ‘experience of illness is inherently subjective’, suggesting that researchers or clinicians with personal experience could help smooth the divide between the subjective experience and interpretation of symptoms, and the objective approach to diagnosing and managing illness.3
Dual expertise is a complementary, underestimated resource. It does not necessarily compromise rigour, nor does it dilute professionalism. When recognised, dual expertise strengthens co production and brings research and clinical practice into closer alignment with the realities of those it is designed to serve.
References
- Social Care Institute for Excellence. Co-production: what it is and how to do it. https://www.scie.org.uk/co-production/what-how/ Accessed 6.10.26
- Wakefield D. Home. The Lancet, 406, 2989-2990.
- Gergel T. Lived experience research: recognition of dual expertise. The Lancet Psychiatry, 2026; 13, 818-820.
Featured photo by Bhautik Patel on Unsplash.
