6 ms·

Finally. The idea for a checklist in clinical settings was originally conceived by Peter Pronovost at Johns Hopkins. Last year, Gawande wrote an awesome essay

by dcurtis 18y ago

Finally. The idea for a checklist in clinical settings was originally conceived by Peter Pronovost at Johns Hopkins. Last year, Gawande wrote an awesome essay for the New Yorker about the ICU checklists that were attempted in the US (saving hundreds of lives) but eventually cancelled by regulatory authorities-- "If you're changing the way things are done, you need to perform controlled FDA-approved studies." http://www.newyorker.com/reporting/2007/12/10/071210fa_fact_gawande http://www.newyorker.com/reporting/2007/12/10/071210fa_fact_... Also, you should read his book Better, which is just page after page of interesting stuff; Atul Gawande is the Malcom Gladwell of medicine, but I think his stuff is far more engaging.

Alex3917 18y ago
This combined with How Doctors Think made me realize that our doctors in the US are really no better than witch doctors. In fact in some ways going to a shaman is probably better. They are less likely to cure you, but they are also vastly less likely to kill you by accident. A pretty good tradeoff, considering that medical accidents are the leading cause of death in the US. http://www.ourcivilisation.com/medicine/usamed/deaths.htm http://www.ourcivilisation.com/medicine/usamed/deaths.htm http://www.ourcivilisation.com/medicine/usamed.htm http://www.ourcivilisation.com/medicine/usamed.htm And this isn't even counting the fact that none of our antibiotics are working anymore because our medical system sees fit to use over 70% of our total antibiotics produced each year in animal feed.
- andreyf 18y ago
  medical accidents are the leading cause of death in the US I thought it was obesity? Or smoking? Or drinking and driving? none of our antibiotics are working anymore I don't know, they worked great both when I had lyme disease and when I had bronchitis...
  - Alex3917 18y ago
    "I thought it was obesity? Or smoking? Or drinking and driving?" Obesity isn't as dangerous as was previously thought, not that many people smoke anymore, and the dangers of driving after a drink or two are vastly overstated. "I don't know, they worked great both when I had lyme disease and when I had bronchitis..." Probably not penicillin.
- deleted 18y ago
  [deleted]
  - deleted 18y ago
    [deleted]
- msg 18y ago
  That is so not what your link says. http://en.wikipedia.org/wiki/List_of_causes_of_death_by_rate http://en.wikipedia.org/wiki/List_of_causes_of_death_by_rate The leaders are heart disease, infection, and cancer (from this 2002 table, sourced to WHO).
  - Alex3917 18y ago
    That chart is worldwide, not US. And iatrogenic deaths wouldn't be in the chart anyway because there are ten or fifteen different types, most of which would fall under another category.
    - msg 18y ago
      Fine, here's the US data for 2005 from the CDC. I don't think you can ascribe deaths from heart disease, cancer, stroke, lung disease, diabetes, and Alzheimer's to doctor error. Most come from lifestyle choices. Cigarettes, junk food, and no exercise make Homer something something (DIE EARLY). You might strengthen your argument for me if you talk about proximate vs underlying causes of death. We're all going to die. http://www.cdc.gov/nchs/FASTATS/lcod.htm http://www.cdc.gov/nchs/FASTATS/lcod.htm Quote: (Data are for U.S. for year indicated) Number of deaths for leading causes of death Heart disease: 652,091 Cancer: 559,312 Stroke (cerebrovascular diseases): 143,579 Chronic lower respiratory diseases: 130,933 Accidents (unintentional injuries): 117,809 Diabetes: 75,119 Alzheimer's disease: 71,599 Influenza/Pneumonia: 63,001 Nephritis, nephrotic syndrome, and nephrosis: 43,901 Septicemia: 34,136 Source: Deaths: Final Data for 2005, Table C
      - Alex3917 18y ago
        I understand that iatrogenic deaths aren't in the table. And I do think the 800,000 figure the site I linked to may be too high. But almost certainly medical errors are the number three cause of death. Think about it this way. If your chance of getting MRSA during surgery drops from 4% to 0% if your doctor uses a simple 6-item checklist, imagine all the other ways that doctors are hurting people. Plus, heart attacks are usually the cause of death when your doctor prescribes either the wrong medicine or the wrong dosage, or prescribes the right medicine but gives it to the wrong person.
- yummyfajitas 18y ago
  While your stats are nonsensical and incorrect, I agree there is a big problem with Witch Doctor, M.D. An experience I once had: Me: I have nerve pain in my pinky and right side of the forearm. [Shows the doctor where it hurts.] Dr: You are a programmer. I think you have carpal tunnel syndrome. Me: I've got pain in my forearm. Also, the ulnar nerve is what connects to the pinky, and that doesn't pass through the carpal tunnel. Are you sure about that? Dr: Are you questioning my judgement? I'm happy to say I have found a doctor who does practice the scientific method. Unfortunately, not all do.
  - Alex3917 18y ago
    "I'm happy to say I have found a doctor who does practice the scientific method. Unfortunately, not all do." In the book How Doctors Think, they show a statistic that the vast majority of doctors make up their minds about what's wrong with you in the first thirty seconds and then never reconsider no matter what you say or the evidence suggests. This is one of the advantages of going to see a naturopathic doctor in addition to an allopathic doctor. They will actually sit down with you for a 45 minutes and discuss your health, diet, exercise, etc. This would be unthinkable for 99% of normal doctors. While it's true that allopathic doctors should be trained to take your diet and such into account when trying to figure out how to cure you, the fact is that none do. So you could have depression that's caused by a lack of magnesium and your doctor will give your powerful SSRIs, when in reality it could just as easily be cured with a little guacamole. A lot of people will quibble because the example I just gave falls under the myth of what doctors are supposed to do, but if you look at what doctors actually do do then it becomes clear that allopathic medicine is a disaster. Never judge an organization by its mission statement; medicine is no exception. "While your stats are nonsensical and incorrect" They come from JAMA...
    - yummyfajitas 18y ago
      A doctor may try and fail to deliver science-based medicine. Some doctors are even intellectually incapable of doing this, and practice cargo cult medicine (compare to cargo cult programmers). They vaguely follow some science-based procedures without really understanding what they are doing. A naturopathic "doctor" does not even attempt to use science, at least not consistently. Naturopathic medicine is feel-good mumbo jumbo. Some of it works (your guacamole example), some of it is utterly wrong (homeopathy) but still used. Naturopathic medicine does not, even in principle, attempt to use science-based medicine. Science-based medicine, like most human endeavors, is flawed. It doesn't always do what it should do. The solution is more science, not the complete abandonment of science in favor of new-age nature-worshipping religion. As for your stats, just FAIL. One example: There are 98,000 medical-mistake caused deaths. The 37,136 deaths due to unnecessary procedures and the 32,000 surgery related deaths are a subset of the 98,000 medical errors. You just can't add them, which your source does. I'll illustrate the mistake with cows: I have 98,000 cows. In particular, I have 37,136 black cows and 32,000 white cows. Therefore, I have at least 167,136 cows.
- omouse 18y ago
  I'm going to be as nice and polite as I can be here. Medical science has had a long history, at least a few hundred years and performs studies/experiments/etc. to make sure that things work. Witch doctors try random shit and see what sticks to the wall even if it means the patient dies. Do you see the difference? If doctors were killing a lot of people, I'm sure journalists would have jumped all over it by now and a lot of doctors would have malpractice suits filed against them. Antibiotics do work. There have been studies to prove that. This isn't the small-time, this isn't the minor leagues, these pharma-companies are paying a big chunk of change to make sure something useful happens when you take those pills. If you want lies and deceit, I suggest you go to a "natural" "organic" pharmacy that sells homeopathic garbage.
  - Alex3917 18y ago
    "Medical science has had a long history, at least a few hundred years and performs studies/experiments/etc. to make sure that things work." And when push comes to shove, there's a simple procedure that can cut your risk of dying from surgery in half, and it's illegal for your doctor to use it in the US. As in if they do, they lose their medical license and go to jail. Why? It's insane. "One of the sad realities of ignoring history is that almost every American is ignorant of the fact that medical freedom was tragically left out of the American Constitution. In 1776, Dr. Benjamin Rush, Surgeon General and the only American doctor to sign the Declaration of Independence, tried strenuously, but failed, to have "medical freedom" enshrined in the Constitution. He stated "The constitution of this Republic should make special provisions for Medical Freedom. To restrict the art of healing to one class of men and deny equal privileges to others will constitute the Bastille of medical science. All such laws are un-American and despotic." If this amendment were actually enacted then probably your risk of dying in surgery would be 50% of what it actually is today.
  - RK 18y ago
    these pharma-companies are paying a big chunk of change to make sure something useful happens when you take those pills. Unfortunately, it's not always clear that those drugs do work. The problem isn't in the scientific process, but how it's often carried out and reported by the companies, who know exactly what it takes to get FDA approval (this is BIG business). I'm interested in how this process can be improved. The "alternative/complementary" medicine thing is a red herring, to be polite. Here's an interesting article that discusses some of the less than ideal ways that pharmacy companies report the science behind the drugs they develop, among other things. http://www.nybooks.com/articles/22237 http://www.nybooks.com/articles/22237 I think it's an important and interesting issue that needs to be addressed better (probably by the government).
- cturner 18y ago
  > This combined with How Doctors Think made me realize > that our doctors in the US are really no better than > witch doctors. You don't want to go around saying things like that - you're pushing economics out of their similie that is wholely theirs.
stcredzero 18y ago
...You mean freaking surgeons haven't been using checklists? People who are about to do something as complicated, delicate, and life-critical as surgery haven't been using checklists!? FFS! My friends use checklists to go @&#^%%$ camping! That's almost as bad as doing dynamic language programming without Unit Tests. :) - for the humor impaired
- noonespecial 18y ago
  As a pilot, I've often contemplated this myself with some sense of sick wonder. Flying a plane is trivial compared to surgery but overlooking something important has equally dire consequences, so all pilots everywhere are taught to always use checklists. It works wonderfully. I just can't imagine going into something so life and death with a "I'm pretty good at remembering everything" attitude!
  - stcredzero 18y ago
    (To anyone overly sensitive reading the grandparent post -- Note that I am a Smalltalker.) My sister says: "Unless someone might lose their life or a limb, it's not a Big Deal." To this, I'm going to add: "If it really is a Big Deal, then FFS, use a checklist!"
  - bilch 18y ago
    The usual explanation for this pilot/surgeon difference is: Surgeons don't go down with their patient.
likpok 18y ago
And why shouldn't they do a controlled FDA-approved study? Medicine is a /science/ which means we need to test things, rather than relying on "common-knowledge". If it is as effective as you say, a study should be fairly easy to set up.
- dcurtis 18y ago
  They did set up a study, informally, like you would do in most sciences for an exploratory experiment. But it was shut down by the FDA. And to comply with FDA rules (which are designed specifically for drug testing and exploring new surgical processes) it would have taken six years and been too expensive for their budget. So they went to the UK and completed the study in six months for free. The US lost out on that.
- mhartl 18y ago
  You're conflating "scientific studies" with "FDA-approved studies". The former proceed at whatever pace makes sense for medicine and for patients; the latter proceed at the speed of molasses.
- xenophanes 18y ago
  It's great to do a study, but in the meantime can anyone explain how a checklist could be dangerous? If you can't give any ways, then it's silly to ban it for now. This isn't a new medicine with potential unknown effects.
  - dcurtis 18y ago
    They example they gave was this: Imagine you're operating on a person and you accidentally leave a sponge deep inside their abdomen. The nurse, following the checklist, tells you and you go back in and remove it. In the process, you cut an artery and kill the patient. The patient's family claims the hospital was performing an "experiment" on the patient because without the checklist they would not have gone back in to remove the sponge and the patient would have lived. Obviously, this is stupid. But cases have been won on this principle, which shows legal precedence. When the FDA came knocking, the hospitals, afraid of lawsuits, complied.

by dcurtis 18y ago

Alex3917 18y ago

This combined with How Doctors Think made me realize that our doctors in the US are really no better than witch doctors. In fact in some ways going to a shaman is probably better. They are less likely to cure you, but they are also vastly less likely to kill you by accident. A pretty good tradeoff, considering that medical accidents are the leading cause of death in the US. http://www.ourcivilisation.com/medicine/usamed/deaths.htm http://www.ourcivilisation.com/medicine/usamed/deaths.htm http://www.ourcivilisation.com/medicine/usamed.htm http://www.ourcivilisation.com/medicine/usamed.htm And this isn't even counting the fact that none of our antibiotics are working anymore because our medical system sees fit to use over 70% of our total antibiotics produced each year in animal feed.

andreyf 18y ago
medical accidents are the leading cause of death in the US I thought it was obesity? Or smoking? Or drinking and driving? none of our antibiotics are working anymore I don't know, they worked great both when I had lyme disease and when I had bronchitis...
- Alex3917 18y ago
  "I thought it was obesity? Or smoking? Or drinking and driving?" Obesity isn't as dangerous as was previously thought, not that many people smoke anymore, and the dangers of driving after a drink or two are vastly overstated. "I don't know, they worked great both when I had lyme disease and when I had bronchitis..." Probably not penicillin.
deleted 18y ago
[deleted]
- deleted 18y ago
  [deleted]
msg 18y ago
That is so not what your link says. http://en.wikipedia.org/wiki/List_of_causes_of_death_by_rate http://en.wikipedia.org/wiki/List_of_causes_of_death_by_rate The leaders are heart disease, infection, and cancer (from this 2002 table, sourced to WHO).
- Alex3917 18y ago
  That chart is worldwide, not US. And iatrogenic deaths wouldn't be in the chart anyway because there are ten or fifteen different types, most of which would fall under another category.
  - msg 18y ago
    Fine, here's the US data for 2005 from the CDC. I don't think you can ascribe deaths from heart disease, cancer, stroke, lung disease, diabetes, and Alzheimer's to doctor error. Most come from lifestyle choices. Cigarettes, junk food, and no exercise make Homer something something (DIE EARLY). You might strengthen your argument for me if you talk about proximate vs underlying causes of death. We're all going to die. http://www.cdc.gov/nchs/FASTATS/lcod.htm http://www.cdc.gov/nchs/FASTATS/lcod.htm Quote: (Data are for U.S. for year indicated) Number of deaths for leading causes of death Heart disease: 652,091 Cancer: 559,312 Stroke (cerebrovascular diseases): 143,579 Chronic lower respiratory diseases: 130,933 Accidents (unintentional injuries): 117,809 Diabetes: 75,119 Alzheimer's disease: 71,599 Influenza/Pneumonia: 63,001 Nephritis, nephrotic syndrome, and nephrosis: 43,901 Septicemia: 34,136 Source: Deaths: Final Data for 2005, Table C
    - Alex3917 18y ago
      I understand that iatrogenic deaths aren't in the table. And I do think the 800,000 figure the site I linked to may be too high. But almost certainly medical errors are the number three cause of death. Think about it this way. If your chance of getting MRSA during surgery drops from 4% to 0% if your doctor uses a simple 6-item checklist, imagine all the other ways that doctors are hurting people. Plus, heart attacks are usually the cause of death when your doctor prescribes either the wrong medicine or the wrong dosage, or prescribes the right medicine but gives it to the wrong person.
yummyfajitas 18y ago
While your stats are nonsensical and incorrect, I agree there is a big problem with Witch Doctor, M.D. An experience I once had: Me: I have nerve pain in my pinky and right side of the forearm. [Shows the doctor where it hurts.] Dr: You are a programmer. I think you have carpal tunnel syndrome. Me: I've got pain in my forearm. Also, the ulnar nerve is what connects to the pinky, and that doesn't pass through the carpal tunnel. Are you sure about that? Dr: Are you questioning my judgement? I'm happy to say I have found a doctor who does practice the scientific method. Unfortunately, not all do.
- Alex3917 18y ago
  "I'm happy to say I have found a doctor who does practice the scientific method. Unfortunately, not all do." In the book How Doctors Think, they show a statistic that the vast majority of doctors make up their minds about what's wrong with you in the first thirty seconds and then never reconsider no matter what you say or the evidence suggests. This is one of the advantages of going to see a naturopathic doctor in addition to an allopathic doctor. They will actually sit down with you for a 45 minutes and discuss your health, diet, exercise, etc. This would be unthinkable for 99% of normal doctors. While it's true that allopathic doctors should be trained to take your diet and such into account when trying to figure out how to cure you, the fact is that none do. So you could have depression that's caused by a lack of magnesium and your doctor will give your powerful SSRIs, when in reality it could just as easily be cured with a little guacamole. A lot of people will quibble because the example I just gave falls under the myth of what doctors are supposed to do, but if you look at what doctors actually do do then it becomes clear that allopathic medicine is a disaster. Never judge an organization by its mission statement; medicine is no exception. "While your stats are nonsensical and incorrect" They come from JAMA...
  - yummyfajitas 18y ago
    A doctor may try and fail to deliver science-based medicine. Some doctors are even intellectually incapable of doing this, and practice cargo cult medicine (compare to cargo cult programmers). They vaguely follow some science-based procedures without really understanding what they are doing. A naturopathic "doctor" does not even attempt to use science, at least not consistently. Naturopathic medicine is feel-good mumbo jumbo. Some of it works (your guacamole example), some of it is utterly wrong (homeopathy) but still used. Naturopathic medicine does not, even in principle, attempt to use science-based medicine. Science-based medicine, like most human endeavors, is flawed. It doesn't always do what it should do. The solution is more science, not the complete abandonment of science in favor of new-age nature-worshipping religion. As for your stats, just FAIL. One example: There are 98,000 medical-mistake caused deaths. The 37,136 deaths due to unnecessary procedures and the 32,000 surgery related deaths are a subset of the 98,000 medical errors. You just can't add them, which your source does. I'll illustrate the mistake with cows: I have 98,000 cows. In particular, I have 37,136 black cows and 32,000 white cows. Therefore, I have at least 167,136 cows.
omouse 18y ago
I'm going to be as nice and polite as I can be here. Medical science has had a long history, at least a few hundred years and performs studies/experiments/etc. to make sure that things work. Witch doctors try random shit and see what sticks to the wall even if it means the patient dies. Do you see the difference? If doctors were killing a lot of people, I'm sure journalists would have jumped all over it by now and a lot of doctors would have malpractice suits filed against them. Antibiotics do work. There have been studies to prove that. This isn't the small-time, this isn't the minor leagues, these pharma-companies are paying a big chunk of change to make sure something useful happens when you take those pills. If you want lies and deceit, I suggest you go to a "natural" "organic" pharmacy that sells homeopathic garbage.
- Alex3917 18y ago
  "Medical science has had a long history, at least a few hundred years and performs studies/experiments/etc. to make sure that things work." And when push comes to shove, there's a simple procedure that can cut your risk of dying from surgery in half, and it's illegal for your doctor to use it in the US. As in if they do, they lose their medical license and go to jail. Why? It's insane. "One of the sad realities of ignoring history is that almost every American is ignorant of the fact that medical freedom was tragically left out of the American Constitution. In 1776, Dr. Benjamin Rush, Surgeon General and the only American doctor to sign the Declaration of Independence, tried strenuously, but failed, to have "medical freedom" enshrined in the Constitution. He stated "The constitution of this Republic should make special provisions for Medical Freedom. To restrict the art of healing to one class of men and deny equal privileges to others will constitute the Bastille of medical science. All such laws are un-American and despotic." If this amendment were actually enacted then probably your risk of dying in surgery would be 50% of what it actually is today.
- RK 18y ago
  these pharma-companies are paying a big chunk of change to make sure something useful happens when you take those pills. Unfortunately, it's not always clear that those drugs do work. The problem isn't in the scientific process, but how it's often carried out and reported by the companies, who know exactly what it takes to get FDA approval (this is BIG business). I'm interested in how this process can be improved. The "alternative/complementary" medicine thing is a red herring, to be polite. Here's an interesting article that discusses some of the less than ideal ways that pharmacy companies report the science behind the drugs they develop, among other things. http://www.nybooks.com/articles/22237 http://www.nybooks.com/articles/22237 I think it's an important and interesting issue that needs to be addressed better (probably by the government).
cturner 18y ago
> This combined with How Doctors Think made me realize > that our doctors in the US are really no better than > witch doctors. You don't want to go around saying things like that - you're pushing economics out of their similie that is wholely theirs.

stcredzero 18y ago

...You mean freaking surgeons haven't been using checklists? People who are about to do something as complicated, delicate, and life-critical as surgery haven't been using checklists!? FFS! My friends use checklists to go @&#^%%$ camping! That's almost as bad as doing dynamic language programming without Unit Tests. :) - for the humor impaired

noonespecial 18y ago
As a pilot, I've often contemplated this myself with some sense of sick wonder. Flying a plane is trivial compared to surgery but overlooking something important has equally dire consequences, so all pilots everywhere are taught to always use checklists. It works wonderfully. I just can't imagine going into something so life and death with a "I'm pretty good at remembering everything" attitude!
- stcredzero 18y ago
  (To anyone overly sensitive reading the grandparent post -- Note that I am a Smalltalker.) My sister says: "Unless someone might lose their life or a limb, it's not a Big Deal." To this, I'm going to add: "If it really is a Big Deal, then FFS, use a checklist!"
- bilch 18y ago
  The usual explanation for this pilot/surgeon difference is: Surgeons don't go down with their patient.

likpok 18y ago

And why shouldn't they do a controlled FDA-approved study? Medicine is a /science/ which means we need to test things, rather than relying on "common-knowledge". If it is as effective as you say, a study should be fairly easy to set up.

dcurtis 18y ago
They did set up a study, informally, like you would do in most sciences for an exploratory experiment. But it was shut down by the FDA. And to comply with FDA rules (which are designed specifically for drug testing and exploring new surgical processes) it would have taken six years and been too expensive for their budget. So they went to the UK and completed the study in six months for free. The US lost out on that.
mhartl 18y ago
You're conflating "scientific studies" with "FDA-approved studies". The former proceed at whatever pace makes sense for medicine and for patients; the latter proceed at the speed of molasses.
xenophanes 18y ago
It's great to do a study, but in the meantime can anyone explain how a checklist could be dangerous? If you can't give any ways, then it's silly to ban it for now. This isn't a new medicine with potential unknown effects.
- dcurtis 18y ago
  They example they gave was this: Imagine you're operating on a person and you accidentally leave a sponge deep inside their abdomen. The nurse, following the checklist, tells you and you go back in and remove it. In the process, you cut an artery and kill the patient. The patient's family claims the hospital was performing an "experiment" on the patient because without the checklist they would not have gone back in to remove the sponge and the patient would have lived. Obviously, this is stupid. But cases have been won on this principle, which shows legal precedence. When the FDA came knocking, the hospitals, afraid of lawsuits, complied.