Continuing my very intermittent series of book reviews, my latest read has been ‘Blink’ by Malcolm Gladwell. While I am loath to feature two books by the same author (having already blogged about ‘The Tipping Point’) I felt some of the material discussed was so relevant to veterinary practice and education I needed to share it.
The premise of the book is that the many instantaneous judgements we make every day about people’s attitudes or situations are vital to normal functioning and surprisingly reliable, but also in some situations need to be analysed to avoid stereotyping and generalisation. This type of rapid cognition is known as ‘thin-slicing’ and ‘refers to the ability of our unconscious to find patterns in situations and behaviour based on very narrow slices of experience’. Gladwell gives many examples, such as an art dealer who, on first seeing a ‘ancient’ piece of art which has supposedly been verified as authentic through painstaking research, knows instantly that it is a fake even though she can’t immediately say what it is that prompted the response.
The relationship between communication style and risk of malpractice claims
An application of thin-slicing directly relevant to veterinarians and veterinary educators was a study undertaken to try to identify communication behaviours with high potential to lead to physicians being sued. It has been established that the chance of patients pursuing malpractice claims against physicians relate not to the level of education of the doctor or the quality of care, but to whether they felt the physician was caring and compassionate. A team led by Wendy Levinson assessed whether listening to doctor-patient conversations could give clues as to what communication styles give rise to patient dissatisfaction1. 124 physicians were recruited, about half of whom has been sued while the other half had not. Physician-patient conversations were recorded and the tapes assessed. Significant findings were that the doctors who had not been sued spent significantly longer with their patients and were more likely to make orienting comments like ‘I’ll examine you first and be sure to leave time for your questions after we have discussed the results’. They used more active listening techniques such as, ‘Tell me more about that.’ and were more likely to laugh during the consultation. These features are obviously very important and I feel should be included in communication skills taught in veterinary schools.
A further study by Ambady et al2 illuminated the importance of tone of voice. Amazingly, when the tapes from the original study were altered so that the words were incomprehensible and only tone of voice was able to be assessed, an assessor who had not been involved in the earlier study and did not know which doctors had been sued, could predict with 95% accuracy which group the physician fitted into by evaluating their tone of voice for just 40 seconds.
Assessing clients on first impressions
As all vets know, there are risks in making ‘first impressions’ judgements of clients, particularly around their ability and/or willingness to pay, which in some cases can alter the treatment options offered. I’ve made this mistake in both directions, memorable cases being one man who didn’t look as though he had a cent to his name paying an $800 bill with barely a comment and a woman dressed up to the nines haggling over paying a few dollars for me to perform an ear swab to investigate the cause of her dog’s florid and painful otitis externa.
Gladwell discusses this concept in some depth, in part using an unusually successful salesman, Bob Golomb, as an example. Veterinarians, like it or not, are salespeople to a certain extent so the comments are very relevant. Bob has two rules:
- Take care of the client. Even if you are having a bad day you must give them your best when they visit and follow up afterwards whenever possible and appropriate.
- Never judge anyone on the basis of appearance.
Bob assumes everyone has the same chance of buying. As Gladwell describes it, ‘He has his antennae out to pick up on whether someone is confident or insecure, knowledgeable or naïve, trusting or suspicious – but from that he tries to edit out impressions based solely on physical appearance.’
The crux is that while first impressions are extremely valuable, they need to be actively filtered for elements which introduce an inaccurate bias.
‘Blink’, like all Malcolm Gladwell’s work, is insightful, well-written and full of ‘why have I never thought about it that way?’ moments for the reader. There is much of relevance for veterinarians, veterinary educators and indeed everyone as we all unconsciously use thin slicing every day of our lives.
- Levinson, W et al. (1997), Physician-Patient Communication: The Relationship With Malpractice Claims Among Primary Care Physicians and Surgeons. Journal of the American Medical Association 277(7) pp 553-559
- Ambady, N et al (2002), Surgeon’s tone of voice: A Clue to Malpractice History. Surgery 132(1) pp 5-9