Why doctors need to be more like Malcolm Gladwell

In case you haven’t heard, Malcolm Gladwell recently released his book, David and Goliath.  I’m just about finished reading it.

Just as interesting as the book are its reviews.  In a recent post from Slate, Gladwell himself responds to the criticism.  He freely admits that his books should not be held as pinnacles of academic rigor, but should be considered “intellectual adventures stories.”

He further elaborates on the power of stories, accepting their weaknesses in exchange for their powerful strengths:

Stories necessarily involve ambiguity and contradiction. They do not always capture the full range of human experience. Their conclusions can seem simplified or idiosyncratic. But at the same time stories have extraordinary advantages. They can reach large numbers of people and move them and serve as the vehicle for powerful insights. The overwhelming majority of social scientists that I have encountered in my career appreciate this trade-off and respect writers like me for the efforts we have made to use storytelling to bring the amazing worlds of psychology and sociology to a broader audience.

We need more Malcolm Gladwells in medicine.  We need more storytellers.

The one that probably comes closest to Gladwell’s popularity and writing style is his New Yorker colleague, Atul Gawande.  But he’s just one individual.  Imagine if more physicians could use the power of story to explain why, say, patients don’t necessarily need antibiotics for their cold.  Or why getting that PSA test in an 80-year-old man isn’t necessarily a good idea.

But look at how dry the CDC antibiotic guidelines, or the USPSTF prostate cancer recommendations are.  Yawn, right? It’s no wonder why patient education sometimes falls on deaf ears.

Gladwell’s scientific theories may not always hold up to intense scrutiny, but as a communicator, it’s his message that resonates much more loudly with the public than those who criticize his work.

Doctors should learn from this.  In order for their message to spread, they better learn how to tell a good story.

Why doctors need to be more like Malcolm GladwellKevin Pho is an internal medicine physician and co-author of Establishing, Managing, and Protecting Your Online Reputation: A Social Media Guide for Physicians and Medical Practices. He is on the editorial board of contributors, USA Today, and is founder and editor, KevinMD.com, also on FacebookTwitterGoogle+, and LinkedIn.

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  • southerndoc1

    I thought we were supposed to be serving Starbucks medicine on Cheesecake Airlines. This is getting very confusing . . .

    • ninguem

      You should be Malcolm Gladwell serving Starbucks coffee at the Cheesecake Factory.

  • http://www.davisliumd.blogspot.com Davis Liu, MD

    Completely agree. It is stories which can ignite and inspire change.

  • Shan Siddiqi

    Good point. Whenever I tell a patient something like “the evidence says that ECT is the safest and most effective option in this situation,” I might as well just go ahead and write a prescription for Abilify because they saw it on TV. But if I say something like “I’ve seen people come back from worse, but only really with a treatment plan that includes ECT,” it’s like offering a magic potion. People respond so much better to “here’s a great story with n=1″ than “lots of scientists have done huge double-blind randomized controlled trials about this question.”

    • Disqus_37216b4O

      If a doctor tried that on me, I’d politely point out to him or her that the plural of “anecdote” is not “data”. And ask him or her to stick to quantitative facts.

  • MarylandMD

    Dr Pho, Malcolm Gladwell’s response in Slate was a nasty, thuggish, personal attack on a reviewer of his book that almost completely sidesteps the valid concerns about distortions of science and false claims of generalizability of studies that the reviewer had. I am not sure he should be used as a model for how we physicians should interact with our patients.

    But Gladwell’s ad hominem attack in Slate was very fluent and well written. I do agree we physicians should write and speak gooder.

    • ninguem

      Maryland, I’m glad you posted that.

      I had sent him an E-mail once, about an article where he made certain characterizations of American medicine. Certain bad events happened in the USA, therefore, we should copy………name your country, UK, France, Canada, the usual argument.

      He had an E-mail link, so I responded. A simple Web search showed news reports of the same bad things happening in the countries he held up as an example, in their own press.

      I suggested perhaps a little better research in future articles. Don’t hold up those countries as examples when they have the same problems. It’s not helpful.

      His response to me was along the lines you described.

      I also noticed something else. He really needs the services of an editor.

      Without the editor, he didn’t write too gooder himself.

      • MarylandMD

        “Doesn’t take criticism well.” Not exactly good for your “online reputation”!

  • MarylandMD

    You do make a valid point that we have to present the dry, impersonal facts and guidelines in a way that patients find useful. We need to make the information more personal–more vivid, I guess.

    But using Malcolm Gladwell as an example of how to do this well is not a great idea. I have heard him interviewed, and he can be obstinate to the point of silliness. And many of his assertions, his “stories” if you will, involve false generalization of single studies with a clear disregard of other studies (or basic reality) that make it clear his point is incorrect. To use a medical analogy, it is like Gladwell convincing a 40 year old man without symptoms or risk factors to get an ECG as part of his routine physical by “telling a story” about a former patient who was found to have an abnormality that eventually led to discovery of some previously unknown significant cardiac problem that required intervention. It would be a great “story” that could be told well by Gladwell, but it would be at odds with the current body of research as we know it. And if the patient made a choice based on the “story”, he would expose him self to an increased risk of harm.

    We don’t need “storytellers” like that. We need to stick with the facts.

    And we shouldn’t be obstinate when patients question us.

    And we shouldn’t be a thug and belittle the patient and his wife to boot if he doesn’t agree with us.

    • PJ Dew

      @MarylandMD: It’s not about presenting the “dry, impersonal facts and guidelines in a way the patients find useful”. It’s about educating them and talking to them in a manner that they can comprehend. We all went to school (I’m a nurse), but when it comes to patient education, I’m not there to see how many big words I can use to show that I am smart. When I talk to my patients, I speak “Romper Room”. I break it down so they understand easily what I am saying. That’s all you have to do.

  • Disqus_37216b4O

    “We need more Malcolm Gladwells in medicine.”

    “More” Malcolm Gladwells in medicine? We don’t even have one Malcom Gladwell in medicine. Gladwell is a journalist with a degree in history. He is not a scientist, and has no formal education in sociology, psychology, medicine, or any science-based discipline.

    Of course he’s a great entertainer/storyteller and a good read: he’s a liberal arts grad, that’s what they do. If people want “stories”, they should of course seek out someone like him. But most patients want their doctors to stick to the world of science, of fact. Not tell them “stories”.

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