As I speak to groups around the country one of the most commonly asked questions is, “Why aren’t more doctors recommending nutritional approaches to health problems?” While there are undoubtedly many factors involved, I believe that lack of nutritional knowledge is by far the most significant.

Nearly every individual who enters medical school does so because of a desire to heal and be of service to others. When physicians recommend drugs, surgery, radiation or other treatment options they are, with rare exception, doing so because they believe that they are acting in the best interest of the individual seeking their assistance. The failure to approach problems in a manner that supports the body’s ability to heal rather than in a manner that is injurious to the body is not due to a lack of compassion. It is due to a system of undergraduate, post-doctoral and continuing medical education that at best ignores and at worst ridicules the use of nutritional measures to restore and maintain health.

To appreciate how difficult it is for a physician who has completed his or her training to accept the value of nutritional supplements, bioenergetic supports, spinal manipulation or other “non-conventional” measures to support the body’s healing mechanisms one must recognize that there are four stages learning or four levels of knowledge one must pass through in mastering any subject.

The first level of knowledge is that of “unconscious incompetence.” Simply stated, this is the stage at which individuals “don’t know that they don’t know.” A child who has learned to talk may mistakenly believe that he or she can speak to anyone in the world. The child has not yet learned that people speak many different languages. He or she doesn’t know what he or she doesn’t know.

When a child learns that there are other languages he or she enters the second phase of learning, the level of “conscious incompetence.” The child now “knows that he or she doesn’t know.” A child is not particularly threatened by learning that there is something new to be learned in the area of language. It is simply a matter of recognizing that foreign languages exist. This fact does not threaten the child’s self-image or world view. It just exists.

Most physicians are at the first level of knowledge in the field of nutrition. They don’t know what they don’t know. Unlike the case of the child learning that there are other languages in the world, however, the average physician finds it very hard to accept the fact that there are ways of restoring health that he or she has not mastered. Imagine that you have just invested a total of 11-15 years in preparation for your chosen career. You have completed four years of college, four years of medical school and three to seven years of post-doctoral residency training to become the best physician you can possibly be. You are taking fifty or more hours of continuing medical education each year to improve your competence. How would you respond if a patient asked you about the benefits of something that had never been mentioned in all your years of training? How would you feel if someone came into your office and said, “Doctor, you need to learn more about nutritional supplements!” Although the person meant well, it could be perceived as a threat to your self-image and professional integrity.

The ability of the average physician to accept that there are significant gaps in his or her knowledge and understanding of disease management is further complicated by the demands upon his or her time. Reaching the level of conscious incompetence demands that one either live with the knowledge that one is incompetent or that one take the necessary steps to achieve competence. Imagine that you are a physician spending sixty or more hours per week in the practice of medicine. How would you feel if you suddenly realized that you needed to find time to re-educate yourself? Wouldn’t it be easier to reason that you have already learned everything that is known to be of benefit in the prevention and treatment of disease?

Due to the tremendous investment they have made in their medical education and the often overwhelming demands on their time most physicians will be unable to rise above the level of unconscious incompetence in the field of nutrition. Ignorance is bliss; knowing that you don’t know is torment. Better to take the position that nutritional supplements are unresearched, unlikely to be of any benefit, are potentially dangerous and may interfere with standard treatments than to accept personal incompetence in important aspects of health care and disease management.

When an individual makes a commitment to move forward the level of “conscious competence” is achieved. This is the level at which a person “knows, but has to consciously think about what they know.” The child who has taken up the challenge of learning a second language will at this stage be able to speak and understand the language, but only by internally translating the words to and from his or her first language. Efforts to speak and understand may be slow and clumsy.

In the case of nutritional management of illness a physician who has moved into the stage of conscious competence will find the flow of the day slowed by the frequent necessity of referring back to reference materials. He or she may become frustrated and abandon the attempt to achieve mastery of the information.

The final level of knowledge is that of “unconscious competence.” At this level an individual “knows what he or she knows.” The knowledge flows smoothly, without effort. The child who has reached this level of mastery in a second language can read, listen or speak in that language without needing to internally translate the words. They flow naturally, without effort.

When a physician reaches the level of nutritional “unconscious competence” nutritional modalities will be routinely integrated into any treatment plan. Due to their effectiveness and lack of adverse effects these modalities will generally become the basis for treatment of any condition. More toxic and aggressive approaches will be reserved for advanced conditions in need of them.

I encourage you to honestly appraise your own level of knowledge in various areas. I believe that it is far better for each of us to admit that we are “consciously incompetent” in an area than to deny or ridicule its importance. I readily admit that I don’t possess the knowledge necessary to make repairs on my car. As a nutritional physician I do not possess the ability to perform major surgery. I know almost nothing about drilling for oil and I know that I am not competent to trade commodities.

I believe that it is unrealistic to expect most physicians become experts in nutritional management. I do hope, however, that the day will come when my peers will admit that they are “consciously incompetent” in this area and be willing to consult with those who have taken the steps necessary to become “unconsciously competent.” If a physician says, “We don’t know anything about that, you’d better not take it,” he or she is demonstrating unconscious incompetence. Seek out a physician who is willing to say, “I don’t know much about that but I’m willing to accept what you know or consult with someone who does know more about it.”