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Outliers: The Story of Success Malcolm Gladwell Little, Brown and Company; 2008. 320 pp $30.99 I f you’re a physician reading this review, you are also very likely to be a high achiever. You may believe that hard work and persever- ance lead to success; that by setting goals and focusing your efforts on achieving them, inevitably you will. I am a physician, and I once believed that these ideals applied to everyone. After all, are they not the tenets of the American, and to a lesser degree, the Canadian dream? Malcolm Gladwell’s new book may change your mind. In perhaps his most personal work to date, Outliers: The Story of Success, Gladwell makes the convincing argu- ment that “extraordinary achievement is less about talent than it is about opportunity.” Individuals who have reached unparalleled success in their particular fields — people like Bill Gates, or the Beatles — are outliers. Many physicians are also outliers, albeit to a lesser extent. Perhaps they were the bright ones in their classes, or the most persis- tent at achieving their goals, but unde- niably capable people who achieved some degree of success. Gladwell’s book methodically unravels the myth surrounding this success, writing that it results less from innate genius or ability to surmount formidable academic odds, and more from “a combination of ability, opportunity and utterly arbitrary advantage.” Author of The Tipping Point and staff writer with The New Yorker maga- zine, Gladwell is no stranger to best- seller lists. And with good reason; he cleverly weaves together original research, sociological data and anecdo- tal evidence to explain a range of mod- ern cultural phenomena. Outliers is a breezy, entertaining read. Not all his ideas on success are new; many are echoes of information in the mainstream media. But Glad- well has a gift for succinctly packag- ing arguments for things you may have suspected, but never really confirmed. Have you ever encountered an idiot doctor and wondered how he (or she) made it into medical school? After skimming through Outliers, you won’t wonder. You will smile knowingly. This latest work contains a nod to Gladwell’s homeland (Canada), as he explains how you are unlikely ever to play in the NHL if you are not born in the first few months of the year. Also, witness the amazing (and somewhat intuitive) 10 000 hour rule: You can be excellent at anything as long as you spend 10 000 hours practising. 1 Who knew? Even more relevant to physicians is Gladwell’s riveting description of the communication breakdowns that lead to airline crashes and the role of hierarchical command structures therein. Transpose the setting to a hospital, and you have a nifty insight into the causes of serious, preventable medical errors. Physicians reading Outliers will be humbled and should feel fortunate for their relative successes. Success does not happen by accident. As Gladwell describes most accurately, success is merely an accumulation of advantages related to when and where you were born, your culture and family history, and the circumstances of your upbringing. He reminds us that in order to pull oneself up by one’s bootstraps, one must first have boots. Rashaad Bhyat MB Family physician Toronto, Ont. REFERENCE 1. Omahen D. The 10 000-hour rule and residency training. CMAJ 2009;180:1272 CMAJ • NOVEMBER 24, 2009 • 181(11) © 2009 Canadian Medical Association or its licensors 831 Books A physician’s take on Outliers Humanities DOI:10.1503/cmaj.091832 Physicians reading Outliers will be humbled and should feel fortunate for their relative successes. Previously published at www.cmaj.ca Little, Brown and Company

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Outliers: The Story of SuccessMalcolm GladwellLittle, Brown and Company; 2008.320 pp $30.99

If you’re a physician reading thisreview, you are also very likely tobe a high achiever. You may

believe that hard work and persever-ance lead to success; that by settinggoals and focusing your efforts onachieving them, inevitably you will.

I am a physician, and I oncebelieved that these ideals applied toeveryone. After all, are they not thetenets of the American, and to a lesserdegree, the Canadian dream?

Malcolm Gladwell’s new book maychange your mind.

In perhaps his most personal workto date, Outliers: The Story of Success,Gladwell makes the convincing argu-ment that “extraordinary achievementis less about talent than it is aboutopportunity.”

Individuals who have reachedunparalleled success in their particularfields — people like Bill Gates, or theBeatles — are outliers. Many physi-cians are also outliers, albeit to a lesserextent. Perhaps they were the brightones in their classes, or the most persis-tent at achieving their goals, but unde-niably capable people who achievedsome degree of success. Gladwell’sbook methodically unravels the mythsurrounding this success, writing that itresults less from innate genius or ability

to surmount formidable academic odds,and more from “a combination of abil-ity, opportunity and utterly arbitraryadvantage.”

Author of The Tipping Point andstaff writer with The New Yorker maga-zine, Gladwell is no stranger to best-seller lists. And with good reason; hecleverly weaves together originalresearch, sociological data and anecdo-tal evidence to explain a range of mod-ern cultural phenomena.

Outliers is a breezy, entertainingread. Not all his ideas on success arenew; many are echoes of informationin the mainstream media. But Glad-well has a gift for succinctly packag-

ing arguments for things you mayhave suspected, but never really confirmed.

Have you ever encountered an idiotdoctor and wondered how he (or she)made it into medical school? Afterskimming through Outliers, you won’twonder. You will smile knowingly.

This latest work contains a nod toGladwell’s homeland (Canada), as heexplains how you are unlikely ever toplay in the NHL if you are not born inthe first few months of the year. Also,witness the amazing (and somewhatintuitive) 10 000 hour rule: You canbe excellent at anything as long asyou spend 10 000 hours practising.1

Who knew? Even more relevant to physicians

is Gladwell’s riveting description ofthe communication breakdowns thatlead to airline crashes and the role ofhierarchical command structurestherein. Transpose the setting to ahospital, and you have a nifty insightinto the causes of serious, preventablemedical errors.

Physicians reading Outliers will behumbled and should feel fortunate fortheir relative successes. Success doesnot happen by accident. As Gladwelldescribes most accurately, success ismerely an accumulation of advantagesrelated to when and where you wereborn, your culture and family history,and the circumstances of yourupbringing.

He reminds us that in order to pulloneself up by one’s bootstraps, onemust first have boots.

Rashaad Bhyat MBFamily physicianToronto, Ont.

REFERENCE1. Omahen D. The 10 000-hour rule and residency

training. CMAJ 2009;180:1272

831

Books

A physician’s take on Outliers

HumanitiesD

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10.1

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cmaj