InnovAiT, 11(6), 349
Book Review
Black Box Thinking: The Surprising Truth About Success
Dr Jonathan Mills
Academic Clinical Fellow, Lincoln
Email: jonathanmills1@nhs.net
Authors/editors: Matthew Syed
Year of publication: 2015
ISBN number: 1473613779
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How would you rate this book? (5 star means excellent book useful for
all GPs in training – a must have item; 1 star means poor book that
you would not buy yourself)
What is good about this book?
Black Box Thinking challenges the culture, sadly present in medicine,
that when mistakes occur fingers of blame must be pointed. Mistakes
have a ‘signature pattern’, but one of the tragedies in medicine is how
a closed minded and defensive approach stops change that may pre-
vent recurrent errors. This book emphasises how failure to learn is a
large obstacle to progress. It also raises the important topic of ‘cogni-
tive dissonance’, and how when a mistake is presented clearly to us,
the need to ‘save face’ impedes development.
This book would be of benefit to a wide variety of people, not just
GPs and other allied healthcare professionals. It challenges the reader
to view errors as opportunities to learn rather than apportion blame,
and to be open minded about changing ineffective processes. Syed
makes the point that we learn from actively doing things; that we learn
from action. He also makes the point that young children do not have
a fear of failure; the fear of failure is an acquired trait and not some-
thing we are born with. As clinicians, we talk about children progress-
ing through developmental milestones. Children don’t fear falling over
when trying to walk, they try walking and when they fall, get back up
InnovAiT, 2018, Vol. 11(6), 349, ! The Author(s) 2018.
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again, carry on and learn from it. We learn more by actively doing
tasks ‘bottom-up’ in real life, rather than from ‘top-down’ theory. We
learn by practising skills and we should therefore not expect to be
perfect first time.
Syed discusses the story of how David Beckham continuously
practised his footballing skills, kicking a football many thousands of
times, learning from each attempt, before moving onto a new skill. In
business, Sir James Dyson made thousands of refinements before
patenting his vacuum cleaner (that made him a multi-billionaire),
each iteration learning from the former to make improvements
before arriving at the end product. The key point, illustrated by
these examples, is that we must practise many times, and learn from
each attempt, refining and re-iterating, reflecting on what went well
and what didn’t, before we progress towards mastery of a skill. This is
true not only in sport or business, but in medicine; as clinicians, we
must be prepared to learn from each clinical encounter as we gain
competency.
What is bad about this book?
Opening with cases of airline crashes, medical error and miscarriages
of justice does not make for light reading. While some of the examples
given in the book are predictable, the book makes the point that tragic
events tend to recur. This highlights the importance of embracing a
culture of honest appraisal, of being receptive to change and of find-
ing the root causes of error, rather than looking for scapegoats. The
take-home message is somewhat repetitive: Do not fear failure and
embrace your mistakes so you can learn from them.
DOI: 10.1177/1755738017711466
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