3 ms·

Here is an article about medical checklists that is really eye opening: http://www.newyorker.com/magazine/2007/12/10/the-checklist http://www.newyorker.com/mag

by nols 11y ago

Here is an article about medical checklists that is really eye opening: http://www.newyorker.com/magazine/2007/12/10/the-checklist http://www.newyorker.com/magazine/2007/12/10/the-checklist

mariodiana 11y ago
The most eye opening part about that piece was a letter to the editor, from some bigwig doctor-administrator at a major hospital, that appeared an issue or two later. He thought that the whole idea of checklists was ridiculous, because all that is needed is for everyone to just do what they're supposed to do. Seriously. I'll try to find the letter. (I'm a subscriber and can access back issues online.) To me, his attitude illustrates the biggest problem of the medical profession. How could someone, who we have to suppose is an intelligent human being, miss the entire point of the article! In my opinion, only arrogance explains it.
- mariodiana 11y ago
  Okay, the letter to the editor is from the January 21 issue, a few weeks later. Here's the part I take issue with: "While a retrospective checklist has great value […] a prospective system of protocols, memorized by all the staff and made part of ongoing care, is more likely to influence patient outcomes." You see that part about "memorized by all the staff"? One of the major points of the checklist piece was that simply going by memorized protocols, whether you're going to pilot a plane or perform surgery, just does not cut it. The human animal is prone to failing to follow complicated, extensive protocols from memory. The doctor who wrote the letter is a professor emeritus at a medical school. A screen shot of the letter is here: http://i.imgur.com/0DqhvY0.png http://i.imgur.com/0DqhvY0.png
  - lutorm 11y ago
    The phenomenom you're talking about is called "interrupted checklist" in aviation. Humans are actually quite good at following memorized lists unless they get interrupted mid-task. When this happens, the risk of a mistake goes up significantly, because your mind has already "checked off" the task that you were in the progress of completing when you got interrupted. See for example: http://flighttraining.aopa.org/magazine/2002/October/200210_Instructor_Report_Interrupted_Checklist_.html http://flighttraining.aopa.org/magazine/2002/October/200210_... The psychology behind this is also the reason for the "sterile cockpit" procedures during critical phases of flight. https://en.wikipedia.org/wiki/Sterile_Cockpit_Rule https://en.wikipedia.org/wiki/Sterile_Cockpit_Rule
    - petra 11y ago
      They have implemented a form "sterile cockpit" in some places when nurses prepare medications - by having them wear special vests that signal nobody should interrupt them, and (i think) doing it in a special quiet room.
    - mariodiana 11y ago
      I would have to guess that interruptions happen most often when things don't proceed exactly according to plan; but, honestly, I'm sure that never happens during surgery. (In the interest of full disclosure, I checked the box marked "sarcasm" after writing my reply.)

by nols 11y ago

Here is an article about medical checklists that is really eye opening: http://www.newyorker.com/magazine/2007/12/10/the-checklist http://www.newyorker.com/magazine/2007/12/10/the-checklist

mariodiana 11y ago

The most eye opening part about that piece was a letter to the editor, from some bigwig doctor-administrator at a major hospital, that appeared an issue or two later. He thought that the whole idea of checklists was ridiculous, because all that is needed is for everyone to just do what they're supposed to do. Seriously. I'll try to find the letter. (I'm a subscriber and can access back issues online.) To me, his attitude illustrates the biggest problem of the medical profession. How could someone, who we have to suppose is an intelligent human being, miss the entire point of the article! In my opinion, only arrogance explains it.

mariodiana 11y ago
Okay, the letter to the editor is from the January 21 issue, a few weeks later. Here's the part I take issue with: "While a retrospective checklist has great value […] a prospective system of protocols, memorized by all the staff and made part of ongoing care, is more likely to influence patient outcomes." You see that part about "memorized by all the staff"? One of the major points of the checklist piece was that simply going by memorized protocols, whether you're going to pilot a plane or perform surgery, just does not cut it. The human animal is prone to failing to follow complicated, extensive protocols from memory. The doctor who wrote the letter is a professor emeritus at a medical school. A screen shot of the letter is here: http://i.imgur.com/0DqhvY0.png http://i.imgur.com/0DqhvY0.png
- lutorm 11y ago
  The phenomenom you're talking about is called "interrupted checklist" in aviation. Humans are actually quite good at following memorized lists unless they get interrupted mid-task. When this happens, the risk of a mistake goes up significantly, because your mind has already "checked off" the task that you were in the progress of completing when you got interrupted. See for example: http://flighttraining.aopa.org/magazine/2002/October/200210_Instructor_Report_Interrupted_Checklist_.html http://flighttraining.aopa.org/magazine/2002/October/200210_... The psychology behind this is also the reason for the "sterile cockpit" procedures during critical phases of flight. https://en.wikipedia.org/wiki/Sterile_Cockpit_Rule https://en.wikipedia.org/wiki/Sterile_Cockpit_Rule
  - petra 11y ago
    They have implemented a form "sterile cockpit" in some places when nurses prepare medications - by having them wear special vests that signal nobody should interrupt them, and (i think) doing it in a special quiet room.
  - mariodiana 11y ago
    I would have to guess that interruptions happen most often when things don't proceed exactly according to plan; but, honestly, I'm sure that never happens during surgery. (In the interest of full disclosure, I checked the box marked "sarcasm" after writing my reply.)