6 ms·

I can not think of a single good reason to avoid check-lists in the medical field. And the doctors who resist them may very well just be arrogant and elitist. B

I can not think of a single good reason to avoid check-lists in the medical field. And the doctors who resist them may very well just be arrogant and elitist. But there may also be some other reason. I don't know because I'm not a doctor, but I do know there are always things I don't know to consider in unfamiliar fields. Do we have any doctors on the board who could explain a defensible resistance on the part of doctors to using checklists?

794CD01 10y ago
Not a doctor, but familiar with some of the arguments. Visible use of checklists damages patient trust. You may (correctly) argue that patients who see their doctors following checklists should trust them MORE rather than less, but most data shows otherwise. Patient trust is very important not just for improving outcomes (they need to follow your instructions after discharge) but also in selecting a physician. That's why checklist use is higher in the OR, when the patient is unconscious. Checklist use is slower. Virtually all physicians are already overscheduled. Lengthening every visit by 30-50% so that the doctor can go over a checklist that only ends up mattering a tiny percentage of the time means fewer patients get seen.
- petra 10y ago
  The problem of patients not trusting doctors who use checklists seems solvable , maybe via education maybe via other means. It's just a matter of will.
  - 794CD01 10y ago
    I hope so too. However, it is currently a problem.
- danielrhodes 10y ago
  That explanation is so backwards in reasoning it would be humerous if it weren't so pathetic. Sadly you see people citing data over common sense all the time. In this case, the choice between human life and hospital efficiency and "trust" produces a false trade-off: The dire consequences of one choice all but force you to take the other option.
  - 794CD01 10y ago
    Trusting "common sense" over data is irresponsible if not outright delusional.
    - danielrhodes 10y ago
      Is that always true?
leonth 10y ago
I am not a doctor, but I do have several practical defenses (I don't want to go through political ones). There are many business processes in the healthcare field, and the impact and ease of imposing checklists will be naturally very different for each: * Diagnosis and treatment protocols / pathways - these span long periods of time (days to months), any checklist will probably be quite complex and redundant to the already existing longitudinal case notes. * Procedures (like surgeries) - some parts like preparation can be subject to checklist. But the procedure itself may need >= 2 clean hands and good concentration, thus glancing over checklists multiple times during procedure, or worse attempting to tick off stuff might cause more harm than good. (don't tell me to add one more guy there - we need him to save another patient, and google glass is dead for now) * Processes related to ordering, dispensing, and administering medicines: there are probably tens/hundreds of thousands of these processes happening in a hospital at any given day. If a checklist introduces speed penalty it will be rather burdensome for the facility (and patients too). Furthermore, an equivalent of a checklist (e.g. refusing to proceed unless certain required fields are filled) has usually been codified in the hospital systems being used. Also, I feel that adding a checklist for something that you do hundreds of times a day, will not achieve anything, because the muscle memory will take over - you will just do things as per usual and sign off "all done" on the checklist, because you always do them all the time whether you remember or not, right?
- flarg 10y ago
  Handling of medicines has check-lists; surgery is moving that way too. Diagnosis is complex but also amenable to check-lists.
- ams6110 10y ago
  Surgical nurses can handle the checklists. Of course the surgeon himself will not be ticking boxes. Analogous: in a multi-crew aircraft, one pilot is flying, the other is managing/monitoring (including the checklists).
- petra 10y ago
  >>>Diagnosis and treatment protocols / pathways Even with what you say, clinical decision support(which can be viewed as an automated system of double checking) have shown to lead to better care.
IndianAstronaut 10y ago
It is likely the same reasoning behind why doctors for ages refused to wash their hands...arrogance.

794CD01 10y ago

Not a doctor, but familiar with some of the arguments. Visible use of checklists damages patient trust. You may (correctly) argue that patients who see their doctors following checklists should trust them MORE rather than less, but most data shows otherwise. Patient trust is very important not just for improving outcomes (they need to follow your instructions after discharge) but also in selecting a physician. That's why checklist use is higher in the OR, when the patient is unconscious. Checklist use is slower. Virtually all physicians are already overscheduled. Lengthening every visit by 30-50% so that the doctor can go over a checklist that only ends up mattering a tiny percentage of the time means fewer patients get seen.

petra 10y ago
The problem of patients not trusting doctors who use checklists seems solvable , maybe via education maybe via other means. It's just a matter of will.
- 794CD01 10y ago
  I hope so too. However, it is currently a problem.
danielrhodes 10y ago
That explanation is so backwards in reasoning it would be humerous if it weren't so pathetic. Sadly you see people citing data over common sense all the time. In this case, the choice between human life and hospital efficiency and "trust" produces a false trade-off: The dire consequences of one choice all but force you to take the other option.
- 794CD01 10y ago
  Trusting "common sense" over data is irresponsible if not outright delusional.
  - danielrhodes 10y ago
    Is that always true?

leonth 10y ago

I am not a doctor, but I do have several practical defenses (I don't want to go through political ones). There are many business processes in the healthcare field, and the impact and ease of imposing checklists will be naturally very different for each: * Diagnosis and treatment protocols / pathways - these span long periods of time (days to months), any checklist will probably be quite complex and redundant to the already existing longitudinal case notes. * Procedures (like surgeries) - some parts like preparation can be subject to checklist. But the procedure itself may need >= 2 clean hands and good concentration, thus glancing over checklists multiple times during procedure, or worse attempting to tick off stuff might cause more harm than good. (don't tell me to add one more guy there - we need him to save another patient, and google glass is dead for now) * Processes related to ordering, dispensing, and administering medicines: there are probably tens/hundreds of thousands of these processes happening in a hospital at any given day. If a checklist introduces speed penalty it will be rather burdensome for the facility (and patients too). Furthermore, an equivalent of a checklist (e.g. refusing to proceed unless certain required fields are filled) has usually been codified in the hospital systems being used. Also, I feel that adding a checklist for something that you do hundreds of times a day, will not achieve anything, because the muscle memory will take over - you will just do things as per usual and sign off "all done" on the checklist, because you always do them all the time whether you remember or not, right?

flarg 10y ago
Handling of medicines has check-lists; surgery is moving that way too. Diagnosis is complex but also amenable to check-lists.
ams6110 10y ago
Surgical nurses can handle the checklists. Of course the surgeon himself will not be ticking boxes. Analogous: in a multi-crew aircraft, one pilot is flying, the other is managing/monitoring (including the checklists).
petra 10y ago
>>>Diagnosis and treatment protocols / pathways Even with what you say, clinical decision support(which can be viewed as an automated system of double checking) have shown to lead to better care.

IndianAstronaut 10y ago

It is likely the same reasoning behind why doctors for ages refused to wash their hands...arrogance.