Picoult's ideas can come from a variety of sources, A newspaper article about the Abenaki Indians wanting to protect a piece of land, a burial ground, led to a ghost story "Second Glance." She interviewed members of the Indian tribe and even went on an expedition with three ghost hunters to add authenticity to the tale.
The horrific shooting event at Columbine in Colorado drove her to write "Nineteen Minutes," after interviewing students, teachers, parents and police about how bullying can contribute to such tragedies. A personal connection to the disorder Asberger's Syndrome, a form of autism, convinced her to devote her time and talent to investigating how it affects the family in "House Rules." Here she creates a character, Jacob Hunt, whose passion for crime scene analysis contributes to his being accused of murder.
Medical and ethical issues are often at the heart of her novels, as she plays a literary King Solomon trying to balance the scales of justice. Picoult often speaks in many voices, letting the main characters tell their viewpoints in alternating chapters.
Her novels often have a surprising twist in them, that catches her off-guard herself. “I know the beginning and the end but I don’t know the path it will take and, oh my god, I am often taken by surprise.” Her characters “arrive in my head and I get paid to hear their voices. I see them. It’s organic. But they make decisions on their own and I can’t stop them.”