According to Malcolm Gladwell, that means I can do open heart surgery! Any volunteers?
I have a very low opinion of the difficulty of cardiac surgery,Gladwell confessed. In fact, Gladwell said he believes that operating on a person is not much harder than operating a car.
Driving is insanely complicated,Gladwell exclaimed. There’s anassumption that everyone can learn to drive in a safe way. We don’t question that. There’s no screening. My mother’s 83 — she still drives.
If you can drive a car, you can ultimatelycut into someone’s heart, Gladwell concluded.
I’ve never done surgery on a human heart, that’s true, but I do have an edge: I’ve done animal surgeries, mostly brain surgery, which is, in the conventional wisdom, really hard to do. And unfortunately, I have to confess: even those animal surgeries were a heck of a lot more difficult than driving a car. Just the stitching up afterwards, for instance, is tricky stuff, and it takes a lot of practice to master well. And then there were the little things: I had to eschew coffee before slicing into a cat’s brain, because even tiny tremors were intolerable. You can jump into a car with a giant 64 ounce cup of Mountain Dew, no problem.
But then, of course, Gladwell’s claim isn’t that you could just jump into the operating room and get to work: you have to commit to it first.
I honestly think that…the overwhelming majority of college graduates, given the opportunity, could be better-than-average cardiac surgeons.
That is to say … if we put them through 10,000 hours of deliberate practice, they could all up end being good cardiac surgeons.
I don’t think there’s any magical talent, in other words… If you’re smart enough to get through college, you can be a great surgeon.
Huh. So anyone can be a heart surgeon, if they’re dedicated, invest years of effort in practicing, and master all the learning involved. I can almost agree with that; my experience with animal surgeries was enough to tell me that I had the basic skills and understanding that if I had gone on to medical school, I probably could have done it just fine. But my experience with animal surgeries also made me aware of how difficult it was, that I was not competent to do any surgery that complex then, and that it was going to take an intimidating amount of work to master.
I can also tell you now after years of experience working with college students that no, the majority of them I would not trust to do open heart surgery on me, and most I would not recommend to a medical school. It’s nothing personal, but not everyone is surgeon material — they have other strengths and interests. I’ll just point out that Charles Darwin briefly attended medical school, and he decided it was not something he could do.
The one reassuring thing about Malcolm Gladwell’s attitude, though, is that apparently he believes anyone, with a little practice, could replace Malcolm Gladwell. I strongly urge someone to do so.
Perhaps he has a healthy understanding of heart surgery… but he’s REALLY not safe behind a wheel!
Well, some freshly and humanely butchered chicken perhaps?
Ehm, yes, most people can become pretty competent at a wide variety of things if they study hard and practise a lot. But it’s easier for some than for others.
I guess if I invested 10.000 hours I could become quite good at drawing. Only I have much better things to do with 10.000 hours of my time. my daughter, otoh, is probably half way there already
Even for things of equal difficulty (e.g. not comparing driving and surgery), the consequences of getting something wrong can differ greatly. I still have trouble making a fried egg over easy without breaking the yolk, but I can be trusted to do that. If I had to stand in for a trained anesthesiologist ahead of surgery, I’m not sure that would require more physical dexterity, but I think given the choice most people would rather I fried an egg for them.
He may as well be saying ‘if people were completely different to what they currently are, specifically by becoming a heart surgeon, then they’d be a heart surgeon!’ How amazingly pointless.
Gladwell’s key phrase is “10,000 hours of practice”. Gotcha there. 10,000 hours is not easy. But you (PZ) also got him. 10,000 hours of practice will not make just anyone good at any particular skill. Best counter-example is musicians. Even though a skilled pianist, or violinist, or etc, will put in 10,000 hrs of practice, that does not mean 10,000 hrs is the only requirement to be good at those instruments.
Something about “attitude” and “mindset” has to factored in, somehow. And in my counterexamples, dexterity is vital also. I see the same with cardiac surgery. Surgery demands very fine control of that blade. One might know exactly what has to be done where and how, but actually doing it, even with 10k hrs practice, can be daunting. Gladwell has a lot of interesting observations of “Outliers”, but it is ‘descriptive’ not ‘prescriptive’. Observant but not ‘mentant'(?) [trying to adverbize ‘mentor’]
Well, what we have here is a textbook example of a 100% true statement that misleads horribly by leaving out the important details. Cutting into someone’s heart is easy, and has occasionally even been done by people who were at the time driving a car (badly). Cutting into a heart safely and then putting it back together right on the other hand, is a very different thing.
By stating the average college graduate with 10,000 hour of practice would be better than average, isn’t he implying that his poorly defined practice is better than medical school, residency, surgery training, etc. make doctors worse. I wish he could demonstrate the efficacy of this wonderful training so we can figure out ways to improve medical schools.
It looks like it takes less than 10K hours for Gladwell make himself look like he has no idea what he is talking about.
Well, yes, I could cut into someone’s heart, but as they would then probably end up dead, I’ll leave the heart-cutting to those who know what they are doing. I was happy enough to place my life in the hands of pros last Thursday, when I was having chest pains investigated at hospital.
There was a study recently that would prove Gladwell wrong. The researchers made videos of experienced surgeons performing surgery and had other surgeons rate their performance. There was a huge difference in dexterity and efficiency. Even a layman could tell the difference looking at the videos. And the outcomes for the patients differed–not surprisingly, the better the surgeon, the better the outcome.
Why does anyone bother reading Forbes anymore? It has become an absolute cesspit of anti-science, glibertarian nonsense.
BUT I THOUGHT ALL YOU HAD TO WAS JUST PRACTICE CUTTING OPEN CHESTS FOR 10000 HOURS????
I really don’t like that guy…
Heh…and I was apparently the 10,000th person to reference that… #scrollupstupid
Oh no. He’s spent way more than 10000 hours practicing the art of talking out of his rear…
The Shame Project (Shame the Hacks who Abuse Media Ethics) has an excellent takedown of this overpaid, overrated author/corporate shill. Though if he believes that then that’s enough evidence for me to not trust him.
Nah, surgery is easy. Now getting your patient to survive; _that_ is an advanced move.
I’ve heard of the CSI Effect. Is this the House Effect? Dude, Hugh Laurie just like chops ’em open and sews ’em back up again. Totes easier than drivin’ a car!
Since all heart surgeons are college graduates, this is very difficult to support logically. He’s essentially arguing that students who have the best potential to excel at heart surgery preferentially select other careers by a tremendous margin. I don’t see how one could support that claim.
This falls apart on its face.
Under the circumstances I simply cannot resist! (Simpsons clip, youtube) Now if I ever have heart surgery this is what I’ll think of going in.
Caine@9:
Maybe somebody told him he parallel parks with surgical precision and he just took it really literally? “Ya know what man, now that I think of it…”
Put another way, “The only people who become heart surgeons are the ones who are bad at it.” Clearly, he doesn’t like heart surgeons. Bad experience in his past, maybe?
Three observations:
First, I grew up in a very different society, where the majority of people didn’t know how to drive. Almost all those who DID know how to drive were men. In fact, the country had plenty of cardiac surgeons who couldn’t drive a car. This had less to do with an obsession over what women could do with the mobility supplied by an automobile and more with the notion that driving was an INSANELY COMPLICATED activity that was beyong the ability of female brains to learn. Including women who actually did cardiac surgery — and were respected for it. The point is, to some extent, our ideas about one thing being more complicated than another are cultural.
Two, I think what’s missing from the discussion between Gladwell and physicians is the fact that doing cardiac surgery =/= being a cardiac surgeon. Surgeons do, and are responsible for, so much more than just doing surgery itself. In that limited context, I think one could say that yes, you can teach any reasonably intelligent, college-educated person how to perform cardiac surgery; this doesn’t necessarily mean that having learned that task, the person is now the equivalent of a real physician.
Three, the value of learning by repetition is sadly underappreciated in our society. Instead, most people seem to equate it with “rote memorization” and believe that the ability to perform a complicated activity or solve complex problems is a result of a natural inclination that manifests itself as spontaneous brilliance. Hell, the idea underlying every underdog fantasy is that people who invest time and effort in excelling at something are fakes, because real genius doesn’t need extensive training anyway. Or experience. I am dubious about the 10,000-hour rule in the sense that different fields require different amounts of time and effort to master — but his argument is valuable to the extent that it supports the idea that grindwork is a big part of getting good at something.
Yeah, this was one of the first things I thought of. Beta-blockers are at times abused for steadier hands, by people who have far more than 10,000 hours of practice.
Because there’s a lot more than practice involved.
The majority of us can be better than average.
Uh-huh.
Paging Garrison!
From the Forbes article:
Just a slight diffference….
So, basically, if someone spends the equivalent of five years of full-time work — about the length of a post-grad education — learning a complex skill, they can do that skill. What does Mister Gladwell think medical school and residency is besides learning a complex set of skills?
(Also, while maybe anyone willing and able to devote 10,000 hours to learning can be a surgeon, most people would rather spent that time doing something else. I joke that the primary test of being able to complete a PhD is that you can devote five years to learning everything about a small subject then finding something new and not start loathing whatever subject that is.)
TIL Malcolm Gladwell is a corporate shill.
Damn, I liked his books, and was proud he is a Canuck.
Still, it’s a dollar-driven world we live in and we’re constantly being manipulated.
There’s an on old jewish joke: Two guys are listening to an Enrico Caruso record. One guy says, “He’s an amazing singer.” The other says “Meh, if I had his voice and talent I’d be an amazing singer too.”
Um, what the hell is Gladwell’s point? I seriously do not comprehend what he is trying to say. If you spend 10,000 hours at something the average person can become competent at it? Um, okay…. You know, if you have 6 million dollars you can decorate your living room with nice stuff.
So it appears we have a binary choice: either medical doctors are mediocre hacks who could be replaced by any auto mechanic in a pinch, OR they are uber-brains who can provide perfect opinions on any subject – even subjects they never studied in school (like Ben Carson thinks about himself).
How about this instead: medical doctors are usually people with an enthusiasm and a talent for medicine, who have worked very hard to become very good in their field, AND they are fallible human beings who often know less about subjects outside their field than others do, because they were busy studying and practicing medicine when others were reading about politics, economics, religion, etc.
By this criteria NASCAR drivers are currently all doing brain surgery on conservatives looking for intelligence but the design of the conservative brain won’t allow intelligence.
But wouldn’t it be more effective just to slam the car into them?
In many cases, deciding who SHOULD have surgery, and when, and specifically what kind of surgery needs to be done, is the harder and more important skill than simply doing the surgery itself from a technical standpoint.
This is just wrong. The contingencies involved in brain surgery far out ways the contingencies while driving a car. There is no equality between them. Now this doesn’t argue that not everyone can do brain surgery if trained, but the argument that driving a car requires the same amount of physical skill, anticipatory cognition and just basic knowledge of the territory is not found in evidence. Also, Gladwell is painfully opinionated. He is the Bill O’Reilly of pop-psychology.
#5 twas brillig (stevem)
I think this is supposed to be figured into the definition. At least if Gladwell is referring to “deliberate practice.”
From wikipedia
Contrary to any suggestion that it’s easy to get good at something, my take is that it is very difficult, even for someone who shows initial promise. There is a qualitative difference between a talented dabbler and someone who has put in the effort and self-criticism needed to achieve excellence.
None of this should even be very surprising. “Attitude” isn’t enough either. You could spend years of enthusiastic practice on a hobby (music, tennis, pottery, etc.) and never get beyond the level of an amateur if you’re not taking an analytical interest in what parts need to be improved. 10000 hours of complacent repetition is not 10000 hours of practice.
Less interesting than surgery, perhaps, but:
I wonder if older drivers have to have regular eye tests in his part of the world, or if they have to resit their driving exams periodically to see if they a) still know what they’re doing and b) have any idea how driving laws have changed over their lifetime.
Oh my god! Chuck is having a heart attack! Quick, is there a chauffeur in the restaurant???
In theory, driving a car seems like it could be difficult, but empirical evidence shows that after a few practice sessions, nearly any teenager can get a car from one place to another without killing anyone on the way (most of the time). They can even park the car given a big enough landing strip.
Driving is clearly easier than getting notes (and not screeching) out of a violin or swimming a legal butterfly stroke, both of which require significantly more practice. Comparing it to surgery is ridiculous, though it does not contradict the point that dedication and practice may be more important to becoming a competent surgeon than possessing some ineffable gift for it.
A question for Gladwell. Does it take 10000h of practice to learn to drive a car?
“I wonder if older drivers have to have regular eye tests in his part of the world, or if they have to resit their driving exams periodically to see if they a) still know what they’re doing and b) have any idea how driving laws have changed over their lifetime.”
I don’t know about his part of the world, but when I moved to Florida and went to get my license, the elderly gentleman in line ahead of me at the DMV only had to read the top line of the eye chart and pay his money in order to renew his license.
If Gladwell actually knows what he’s talking about, maybe surgeons are being unfairly required to put too much work into keeping their certifications up to date. Perhaps they should only be asked to point to the heart on a chart of the human body, and write out a check.
Another thing to consider is error tolerance. The average driver probably makes multiple small mistakes and suboptimal driving decisions every day, but those don’t matter for driving competency or safety. A cardiac surgeon who made the equivalent number of small mistakes and suboptimal judgments at an equivalent rate will likely lose his or her license and have a small army of litigants pounding at the door. It may well be that “perfect” driving is just as hard as “perfect” cardiac surgery, but how close one needs to get to perfection to be properly competent is very different between the two.
I’ve never understood this joke, it presumes that “average” splits the group in two equal number of subjects. But I’m no statistician, and I’m possibly lower than average. What am I missing?
There’s an old joke about car mechanic telling heart surgeon that they both have demanding and difficult jobs so why is he being paid less and has less respect and recognition? To which heart surgeon nods and smiles, and then says – “next time try repairing a car without turning the engine off”.
Mehmet Oz is a cardiac surgeon, and Ben Carson is a brain surgeon. Just sayin’…
I’ll bet he took out that “wrenched” ankle before time ran out.
@41- Garrison Kellior closes-out his Lake Woebegone portion of the show A Prairie Home Companion: “. . .where all the children are above average” is the same problem Dwight Eisenhower had when he was shocked to learn that fully half of all Americans were below average intelligence.
Woozy’s joke at #28 reminds me of something I heard at the last blues gathering I attended. The most amazing of the guitarists there said, in all seriousness, “I could play the piano if I could just get my hands to work right.” His wife joined us in the raucous laughter that followed.
Let me note there are a total of 8760 hours in the average year…
10000 hours? That is 3 full working years without sick leave, without holidays, without doing any accompanying administrative work or visiting any lectures. Huh.
To me it seems obvious that talent is just as important as perseverance. Talented person who does not do anything with their talent might not be be as good as not talented but perseverant and hard working person, but they both will inevitably be beaten by anone who perseveres at hard work and has a talent for given task. There are multiple ways how to become good at something – to be talented, to be hard working, to be motivated. But there is only one way to truly excel – to be all of those at once.
I am no surgeon, but I am quite talented for work with my hands. Since early age I could draw above average, I could do miniature wood carving and most manual works I did pick really quickly (well at least untill Morbus Basedowi made my hands shaky). Despite being right handed, I am able to perform a lot of tasks with left hand too, albeit with reduced accuracy. Me not being really good and/or knowledgeable at anything is due to my lack of perseverance on one issue, I tend to lose interest as soon as I am somewhat good at anything and then I search another thing to busy myself with (I guess there is some connection with depressions there).
But when my legs are involved, it is an unmitigated disaster, I am indeed and truly ambisinister. I was totaly unable to learn skiing, I learned to ride bicycle with utmost difficulty and I hate it, and when I learned driving a car with manual clutch (automatic clutch is not standard in EU) my instructor nearly popped a vessel from my clumsiness. I got my driver’s licence and I drive a car, but untill today I have a panic fear of driving any other car thany my own, because I have to be really familiar with the car in order to be able to drive it relliably.
So if I were in my twenties put before a binary choice to eiher learn heart surgery or driving after getting a cursory try of both, I would pick heabrt surgery any time with safe knowledge, that my chances at excelling are better there. But for me to draw generic conclusions form my own peculiarity would indeed be foolish.
I always thought I could solder “surface-mount” circuit boards. Not!
That intimidating amount of time (maybe more than Gladwell’s 10,000 hrs) is the heart of the supervised residencies and fellowships in surgery. Every surgery (except for minor procedures) is a collaborative effort. In most major university medical centers there are several people involved in the actual handiwork of the surgery.
I tend to agree with Gladwell here – from what I have seen the key to competency in a surgical specialty such as cardiothoracic surgery is practice. But surgical or any handiwork skills only go so far. Ben Carson was considered one of the best neurosurgeons and he is an idiot. I just saw a video clip of his thoughts on gay marriage and homosexuality as a choice. Facepalm!
Yes, the jokes all do presume exactly that. It is, of course, possible for every single person except one to above average if that one person is woefully awful enough. However intuition and anecdote assume somewhat standard deviation and distribution and large enough populations so representatives below the average will be matched by equal representatives above the average.
Part of Garison Keillor’s joke is that all the children are above average which is, of course, a contradiction in terms. But it’s really a joke on midwestern humility in that “above average” is the most Lake Woebegone feels comfortable with boasting.
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I really am wondering what is the presumed argument Gladwell seems to be arguing against. He seems to be arguing that surgeons, like nearly every other job on the planet, are qualified competent trained professionals who achieved their abilities through training and experience and that most intellegent people, as with nearly every other job on the planet, with training can do it. But who in the world ever would have thought otherwise??????
How hard can heart surgery be anyway?
J Kerbal
When I was a flight instructor, the motto of our place was ‘we can teach anyone to fly’, but the thing is, that wasn’t really true. Most people can learn given enough time and practice, but some, oh god, no way. I suspect it’s the same for heart surgery. There are just certain people no matter what, won’t ever be able to do it.
#51 woozy
Perhaps giving Gladwell perhaps undue credit here but: I think what he seeks to point out is that the practice is the common thread amongst experts, and that having over 10k hrs of practice at a skill correlates better to expert ability at a particular task better than natural talent for that task correlates to having expert ability in that task (note here that I do mean correlation, not causation). This is not really suprising and of course it does not capture the complexity of becoming an expert at something which of course depends on a large number of different factors.
But why it matters is because it speaks to the overall process of learning – productive time on task is more important than talent in gaining competency. This is exactly opposite to what I hear from most parents of the high school students I teach. They mostly say that if a student is not successful at something then the reason is lack of talent rather than lack of (appropriately structured, productive) time on task. Of course high school courses are not like heart surgery, but correcting this thinking is very important, and ultimately I think the talent over practice argument is what Gladwell is against.
Is he talking manual or automatic transmission? Just trying to grade his idea of what constitutes ‘insanely complicated.’
When confronted on his belief in the ubiquity of skills, Malcolm Gladwell coughed and nervously glanced around, “Well, now, cardiac surgery – that’s easy… writing on the other hand, obviously requires talent…”
(Not An Actual Quote, in case I was being confusing)
When I was younger, Gladwell was one of the writers I really liked. But once I entered college, and started looking into the evidence behind the claims he made, I realized it was mostly all BS. He is a genius at taking a smidgen of an observation and building a very sciencey sounding theory out of it.
Gladwell ignores so much in his claims:
1) Putting 10000 hrs isnt easy and very few are gonna do it, when they could be partying instead.
2) I can’t even cut meat. The idea of doing a surgery would probably cause me to faint.
3) There are very few who even if they had the skill, would be able to maintain the composure and nerve needed to do the surgery.
4) Doing the surgery (while not easy by any means) is the easy part. The hard part is recognizing something has gone wrong, having the cool to make a decision on your feet and save someone’s life. That requires a lot more training than the simple act of doing the surger.
The driving equivalent is being able to recognize and recover from impending accident scenarios. Defensive driving taken to an extreme level.
And not every average driver can do that.
I came here to do heart surgery an’ chew bubblegum…..
I dunno, but for some reason, reading PZ’s summary made me think of Duke Nukem.
Time to go blow some stuff (stuff being pixels) up.
Was the rant supposed to be libertarian ideology, where the reason why surgery is so expensive is because of those darned regulations that prevent perfectly adequate enthusiasts from competing with trained experts?