Excerpt from Blink by Malcolm Gladwell, plus links to reviews, author biography & more

Summary |  Excerpt |  Reading Guide |  Reviews |  Beyond the Book |  Readalikes |  Genres & Themes |  Author Bio


The Power of Thinking Without Thinking

by Malcolm Gladwell

  • Critics' Opinion:

    Readers' Opinion:

  • First Published:
    Jan 2005, 288 pages
    Apr 2007, 320 pages

  • Rate this book

Book Reviewed by:
BookBrowse Review Team

Buy This Book

About this Book

Print Excerpt

By now you are expecting me to say the second option is the best one. You're right, and here's why. Believe it or not, the risk of being sued for malpractice has very little to do with how many mistakes a doctor makes. Analyses of malpractice lawsuits show that there are highly skilled doctors who get sued a lot and doctors who make lots of mistakes and never get sued. At the same time, the overwhelming number of people who suffer an injury due to the negligence of a doctor never file a malpractice suit at all. In other words, patients don't file lawsuits because they've been harmed by shoddy medical care. Patients file lawsuits because they've been harmed by shoddy medical care and something else happens to them.

What is that something else? It's how they were treated, on a personal level, by their doctor. What comes up again and again in malpractice cases is that patients say they were rushed or ignored or treated poorly. "People just don't sue doctors they like," is how Alice Burkin, a leading medical malpractice lawyer, puts it. "In all the years I've been in this business, I've never had a potential client walk in and say, ‘I really like this doctor, and I feel terrible about doing it, but I want to sue him.' We've had people come in saying they want to sue some specialist, and we'll say, ‘We don't think that doctor was negligent. We think it's your primary care doctor who was at fault.' And the client will say, ‘I don't care what she did. I love her, and I'm not suing her.'"

Burkin once had a client who had a breast tumor that wasn't spotted until it had metastasized, and she wanted to sue her internist for the delayed diagnosis. In fact, it was her radiologist who was potentially at fault. But the client was adamant. She wanted to sue the internist. "In our first meeting, she told me she hated this doctor because she never took the time to talk to her and never asked about her other symptoms," Burkin said. "‘She never looked at me as a whole person,' the patient told us. . . . When a patient has a bad medical result, the doctor has to take the time to explain what happened, and to answer the patient's questions—to treat him like a human being. The doctors who don't are the ones who get sued." It isn't necessary, then, to know much about how a surgeon operates in order to know his likelihood of being sued. What you need to understand is the relationship between that doctor and his patients.

Recently the medical researcher Wendy Levinson recorded hundreds of conversations between a group of physicians and their patients. Roughly half of the doctors had never been sued. The other half had been sued at least twice, and Levinson found that just on the basis of those conversations, she could find clear differences between the two groups. The surgeons who had never been sued spent more than three minutes longer with each patient than those who had been sued did (18.3 minutes versus 15 minutes). They were more likely to make "orienting" comments, such as "First I'll examine you, and then we will talk the problem over" or "I will leave time for your questions"—which help patients get a sense of what the visit is supposed to accomplish and when they ought to ask questions. They were more likely to engage in active listening, saying such things as "Go on, tell me more about that," and they were far more likely to laugh and be funny during the visit. Interestingly, there was no difference in the amount or quality of information they gave their patients; they didn't provide more details about medication or the patient's condition. The difference was entirely in how they talked to their patients.

It's possible, in fact, to take this analysis even further. The psychologist Nalini Ambady listened to Levinson's tapes, zeroing in on the conversations that had been recorded between just surgeons and their patients. For each surgeon, she picked two patient conversations. Then, from each conversation, she selected two ten-second clips of the doctor talking, so her slice was a total of forty seconds. Finally, she "content-filtered" the slices, which means she removed the high-frequency sounds from speech that enable us to recognize individual words. What's left after content-filtering is a kind of garble that preserves intonation, pitch, and rhythm but erases content. Using that slice—and that slice alone—Ambady did a Gottman-style analysis. She had judges rate the slices of garble for such qualities as warmth, hostility, dominance, and anxiousness, and she found that by using only those ratings, she could predict which surgeons got sued and which ones didn't.

This is the full text of Chapter 1 of Blink (pages 18-47). Copyright © 2005 by Malcolm Gladwell. All rights reserved. No part of this book maybe reproduced without written permission from the publisher, Little, Brown & Co.

Membership Advantages
  • Reviews
  • "Beyond the Book" backstories
  • Free books to read and review (US only)
  • Find books by time period, setting & theme
  • Read-alike suggestions by book and author
  • Book club discussions
  • and much more!
  • Just $10 for 3 months or $35 for a year
  • More about membership!

Support BookBrowse

Become a Member
and discover your next great read!

Join Today!

Editor's Choice

  • Book Jacket
    Auntie Poldi and the Sicilian Lions
    by Mario Giordano
    Munich matron and self-described worldly sophisticate, Isolde Oberreiter, has decided to retire to a...
  • Book Jacket: Of Arms and Artists
    Of Arms and Artists
    by Paul Staiti
    In the late eighteenth-century, the United States of America was still an emerging country, ...
  • Book Jacket: So Say the Fallen
    So Say the Fallen
    by Stuart Neville
    Noir crime fiction – Raymond Chandler, Dashiell Hammett anyone? – is an American invention...
Book Discussions
Book Jacket
The Bone Tree
by Greg Iles

An epic trilogy of blood and race, family and justice.

About the book
Join the discussion!

First Impressions

  • Book Jacket

    The Comet Seekers
    by Helen Sedgwick

    A magical, intoxicating debut novel, both intimate and epic.

    Read Member Reviews

Win this book!
Win The World of Poldark

Win the book & DVD

Enter to win The World of Poldark and the full first series on DVD.


Word Play

Solve this clue:

One S D N M A S

and be entered to win..

Books that     

 & enlighten

Visitors can view some of BookBrowse for free. Full access is for members only.

Join Today!

Your guide toexceptional          books

BookBrowse seeks out and recommends books that we believe to be best in class. Books that will whisk you to faraway places and times, that will expand your mind and challenge you -- the kinds of books you just can't wait to tell your friends about.


Free Weekly Newsletter

Keep up with what's happening in the world of books:
Reviews, previews, interviews and more!

Spam Free: Your email is never shared with anyone; opt out any time.