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.... They haven't been using checklists? I've been getting so upset at the medical community recently. Pilots solved most of these problems decades ago. We'v

.... They haven't been using checklists? I've been getting so upset at the medical community recently. Pilots solved most of these problems decades ago. We've been trying to help them figure out these tools that we developed to save lives, but it seems like things are only changing one funeral at a time.

_carl_jung 7y ago
They have, since 2008. You're right about pace though, unfortunately rolling out change into bureaucracy is painstakingly slow.
jplayer01 7y ago
Unfortunately, there's a lot of resistance to using checklists, from the nurses to doctors. I wish they'd just swallow their pride and worry more about how to improve than how it makes them look when their mistakes become visible and explicit to the people around them.
- ColinWright 7y ago
  This is something of a case of "Physician - heal thyself". I've advocated the use of checklists in software for decades. I wrote something 5 years ago and posted it here[0][1]. The discussion was enlightening. Read the discussions, keeping in mind the comments here about the resistance encountered by people in the field. Many of the points in the discussions are useful and can be used to create and adapt checklists, but no, they are being used to dismiss them out of hand. Checklists? We don't need to stinkin' checklists. I've given up and just use them in my companies. [0] https://news.ycombinator.com/item?id=7655018 https://news.ycombinator.com/item?id=7655018 [1] https://news.ycombinator.com/item?id=18522627 https://news.ycombinator.com/item?id=18522627
  - lugg 7y ago
    Reminds me of the old you are not done yet list. Couldn't track the one I'm thinking of down but found this: http://www.thebraidytester.com/downloads/YouAreNotDoneYet.pdf http://www.thebraidytester.com/downloads/YouAreNotDoneYet.pd... I feel like I could use a checklist or two.
  - Tade0 7y ago
    Only one company I worked with to date really used checklists and I firmly believe it was one of the reasons they were able to maintain 150k LOC of legacy JavaScript in a single project. One of the others was testing furiously.
- bumby 7y ago
  I wonder how much of this is due to the self-selection of the profession in terms of personalities. Surgery in particular is known to attract Type-A personalities. I witnessed similar attitudes in healthcare and other high-status positions where hubris makes them think they know better...until they have an accident. And even then, there's a strong urge to rationalize the outcome as unavoidable
- amitport 7y ago
  Visible mistakes generate lawsuits. There used to be more processes, removing them was generally a legal necessity.
  - jplayer01 7y ago
    It's not just about lawsuits. I've seen cases (hospitals) where checklists drew pushback from doctors because they didn't like being questioned by nurses who noticed them making mistakes. It impinged on their egos. Implementing checklists requires a certain amount of humility that just isn't there in many cases.
dsfyu404ed 7y ago
"500yr of progress being held back by 500yr of tradition" is highly applicable to the medical profession. There's a lot of arrogance floating around the medical profession as well that tends to put a damper on anything that might reduce human error. Surgeons don't need checklists because they don't make mistakes, unlike those filthy three dimensional bus and truck drivers. /s
- frontloadpro 7y ago
  Physicians are the leading cause of problems in America. Artificially limiting the number of Physicians gives them higher pay at the expense of the Masses.
- throwayEngineer 7y ago
  This explains why the American Medical Association is a top lobbyist. Instead of adapting, they legislate. And the fantasy that Physicians are unfailing experts leaves you after a you regularly interact with them.
  - justaguyhere 7y ago
    I have had the same experience in other countries too, not just the U.S Medical profession really comes across as arrogant and know-it-all, at least in my experience
  - cynoclast 7y ago
    >Instead of adapting, they legislate. This is a source of many vast, seemingly intractable problems. Fucking. Lawyers.
- cptskippy 7y ago
  > "500yr of progress being held back by 500yr of tradition" is highly applicable to the medical profession. Is that true of most professions? The difference being we only really care when lives or large quantities of money are at stake. Probably more the later and less the former unfortunately.
seansmccullough 7y ago
I find it very concerning, using a checklist seems like common sense.
sithadmin 7y ago
>Pilots solved most of these problems decades ago. In the safest planes (commercial airliners), pilots have systems recording their control inputs, and these can be used to directly attribute damage to/loss of the airframe to pilot malfeasance; the shame of a clear screwup will be clearly documented and in most cases, divulged to the public. Medical professionals, on the other hand, seem to face a lower standard of accountability simply because it's truly far more difficult (if not impossible in some cases) to monitor all the variables associated with treating a patient compared to monitoring human-designed systems. I have to wonder if this epistemic quagmire where cause and effect are not necessarily tracked (and in some cases, not even truly understood) leads to a mindset that is more willing to write off negative outcomes as the result of external factors (comorbidity, patient age, patient adherence to physician instructions, even pure luck/probability) than tackle the tough problem of correlating personal behaviors and actions to distinct outcomes.
- BurningFrog 7y ago
  It's not hard to record all patient-doctor interactions. But it is almost certainly illegal in most jurisdictions, supposedly for patient privacy reasons. That this also helps making doctor mistreatment claims hard to prove is hopefully an unintentional side effect. But you have to wonder...
throwaway5752 7y ago
I have been in hospitals and seen them going through checklists with my own eyes. I don't think your assumption is completely accurate. Maybe it depends on the health system, the procedure, or the facility.
arkades 7y ago
The medical community uses checklists. They've been using checklists for a while. A number of studies found that they only help for a few months, while they're new. That said, "the medical community" is not a homogeneous monolith, and you can absolutely find regional variation in what checklists are used for, how detailed they are, how closely they're followed, how people are accountable for keeping to them, etc. >I've been getting so upset at the medical community recently http://www.paulgraham.com/submarine.html http://www.paulgraham.com/submarine.html Don't confuse media narratives with what's actually going on in the medical community. It's a sure-fire way to get (a) upset, and (b) entirely misled. Medical science has been a major target for media FUD for ages.
DanBC 7y ago
They have been using checklists. This news is that they've measured how much harm has been prevented. It's the first country (Scotland) level research. > The findings, reported in the April 17 British Journal of Surgery, are based on an analysis of 6.8 million operations performed between 2000 and 20014. The Surgical Safety Checklist was introduced in Scotland in 2008 as part of the Scottish Patient Safety Programme, and by 2014 the rate had decreased by 36.6 percent over six years to 0.46 deaths per 100 procedures. Researchers noted that this fall in death rates was not seen in patients who did not have surgery.
- jamesblonde 7y ago
  I read in this New Yorker article that Spain introduced checklists in 2007. Does anybody know the results of checklists there? https://www.newyorker.com/magazine/2007/12/10/the-checklist https://www.newyorker.com/magazine/2007/12/10/the-checklist
mbar84 7y ago
I think part of the reason pilots are so diligent is that it's their own lives on the line too...

_carl_jung 7y ago

They have, since 2008. You're right about pace though, unfortunately rolling out change into bureaucracy is painstakingly slow.

jplayer01 7y ago

Unfortunately, there's a lot of resistance to using checklists, from the nurses to doctors. I wish they'd just swallow their pride and worry more about how to improve than how it makes them look when their mistakes become visible and explicit to the people around them.

ColinWright 7y ago
This is something of a case of "Physician - heal thyself". I've advocated the use of checklists in software for decades. I wrote something 5 years ago and posted it here[0][1]. The discussion was enlightening. Read the discussions, keeping in mind the comments here about the resistance encountered by people in the field. Many of the points in the discussions are useful and can be used to create and adapt checklists, but no, they are being used to dismiss them out of hand. Checklists? We don't need to stinkin' checklists. I've given up and just use them in my companies. [0] https://news.ycombinator.com/item?id=7655018 https://news.ycombinator.com/item?id=7655018 [1] https://news.ycombinator.com/item?id=18522627 https://news.ycombinator.com/item?id=18522627
- lugg 7y ago
  Reminds me of the old you are not done yet list. Couldn't track the one I'm thinking of down but found this: http://www.thebraidytester.com/downloads/YouAreNotDoneYet.pdf http://www.thebraidytester.com/downloads/YouAreNotDoneYet.pd... I feel like I could use a checklist or two.
- Tade0 7y ago
  Only one company I worked with to date really used checklists and I firmly believe it was one of the reasons they were able to maintain 150k LOC of legacy JavaScript in a single project. One of the others was testing furiously.
bumby 7y ago
I wonder how much of this is due to the self-selection of the profession in terms of personalities. Surgery in particular is known to attract Type-A personalities. I witnessed similar attitudes in healthcare and other high-status positions where hubris makes them think they know better...until they have an accident. And even then, there's a strong urge to rationalize the outcome as unavoidable
amitport 7y ago
Visible mistakes generate lawsuits. There used to be more processes, removing them was generally a legal necessity.
- jplayer01 7y ago
  It's not just about lawsuits. I've seen cases (hospitals) where checklists drew pushback from doctors because they didn't like being questioned by nurses who noticed them making mistakes. It impinged on their egos. Implementing checklists requires a certain amount of humility that just isn't there in many cases.

dsfyu404ed 7y ago

"500yr of progress being held back by 500yr of tradition" is highly applicable to the medical profession. There's a lot of arrogance floating around the medical profession as well that tends to put a damper on anything that might reduce human error. Surgeons don't need checklists because they don't make mistakes, unlike those filthy three dimensional bus and truck drivers. /s

frontloadpro 7y ago
Physicians are the leading cause of problems in America. Artificially limiting the number of Physicians gives them higher pay at the expense of the Masses.
throwayEngineer 7y ago
This explains why the American Medical Association is a top lobbyist. Instead of adapting, they legislate. And the fantasy that Physicians are unfailing experts leaves you after a you regularly interact with them.
- justaguyhere 7y ago
  I have had the same experience in other countries too, not just the U.S Medical profession really comes across as arrogant and know-it-all, at least in my experience
- cynoclast 7y ago
  >Instead of adapting, they legislate. This is a source of many vast, seemingly intractable problems. Fucking. Lawyers.
cptskippy 7y ago
> "500yr of progress being held back by 500yr of tradition" is highly applicable to the medical profession. Is that true of most professions? The difference being we only really care when lives or large quantities of money are at stake. Probably more the later and less the former unfortunately.

seansmccullough 7y ago

I find it very concerning, using a checklist seems like common sense.

sithadmin 7y ago

>Pilots solved most of these problems decades ago. In the safest planes (commercial airliners), pilots have systems recording their control inputs, and these can be used to directly attribute damage to/loss of the airframe to pilot malfeasance; the shame of a clear screwup will be clearly documented and in most cases, divulged to the public. Medical professionals, on the other hand, seem to face a lower standard of accountability simply because it's truly far more difficult (if not impossible in some cases) to monitor all the variables associated with treating a patient compared to monitoring human-designed systems. I have to wonder if this epistemic quagmire where cause and effect are not necessarily tracked (and in some cases, not even truly understood) leads to a mindset that is more willing to write off negative outcomes as the result of external factors (comorbidity, patient age, patient adherence to physician instructions, even pure luck/probability) than tackle the tough problem of correlating personal behaviors and actions to distinct outcomes.

BurningFrog 7y ago
It's not hard to record all patient-doctor interactions. But it is almost certainly illegal in most jurisdictions, supposedly for patient privacy reasons. That this also helps making doctor mistreatment claims hard to prove is hopefully an unintentional side effect. But you have to wonder...

throwaway5752 7y ago

I have been in hospitals and seen them going through checklists with my own eyes. I don't think your assumption is completely accurate. Maybe it depends on the health system, the procedure, or the facility.

arkades 7y ago

The medical community uses checklists. They've been using checklists for a while. A number of studies found that they only help for a few months, while they're new. That said, "the medical community" is not a homogeneous monolith, and you can absolutely find regional variation in what checklists are used for, how detailed they are, how closely they're followed, how people are accountable for keeping to them, etc. >I've been getting so upset at the medical community recently http://www.paulgraham.com/submarine.html http://www.paulgraham.com/submarine.html Don't confuse media narratives with what's actually going on in the medical community. It's a sure-fire way to get (a) upset, and (b) entirely misled. Medical science has been a major target for media FUD for ages.

DanBC 7y ago

They have been using checklists. This news is that they've measured how much harm has been prevented. It's the first country (Scotland) level research. > The findings, reported in the April 17 British Journal of Surgery, are based on an analysis of 6.8 million operations performed between 2000 and 20014. The Surgical Safety Checklist was introduced in Scotland in 2008 as part of the Scottish Patient Safety Programme, and by 2014 the rate had decreased by 36.6 percent over six years to 0.46 deaths per 100 procedures. Researchers noted that this fall in death rates was not seen in patients who did not have surgery.

jamesblonde 7y ago
I read in this New Yorker article that Spain introduced checklists in 2007. Does anybody know the results of checklists there? https://www.newyorker.com/magazine/2007/12/10/the-checklist https://www.newyorker.com/magazine/2007/12/10/the-checklist

mbar84 7y ago

I think part of the reason pilots are so diligent is that it's their own lives on the line too...