Failing to check all the boxes ...

Norman, Geoff norman at MCMASTER.CA
Fri May 3 00:17:20 UTC 2013


I agree about flying too. For a different reason, which David Cook and I hatched over coffee one day.. First ,all Boeing 737s are pretty much alike, so there's no within patient variation to worry about. Second, all, whatever their age, are maintained like athletes in the Boston marathon. Third all critical systems are backed up 3 times.

If every patient you say had 3 hearts, 3 livers, 6 kidneys and 6 lungs, and they were all independent and could be replaced prophylactically as required, your life as docs would be a whole lot simpler. YOu'd be like Maytag repairmen.

The analogy with a 747 crashing every 13 seconds always struck me as very weak.

BTW, there is evidence in radiology and ECG interpretation that checklists do more harm than good, even with novices. And in education with OSCEs tons of evidence that checklists are no more reliable and less valid\ that a single global rating scale.

Geoff

On 2013-05-01, at 10:16 PM, <Michael.H.Kanter at KP.ORG>
 wrote:

> i agree with you on the flying being prefered over going to an ED,but not for the reason you state.   I would take a well trained pilot without a checklist over a doctor who has a checklist but no concept of teamwork, collaboration, safety culture, and human factors knowledge but is using the checklist in a mechanical non thinking fashion.  Yes, we see the pilots using the checklist but that is simply what we see.  What we dont see is their attitudes about the checklist.  As an example, for years blood transfusion required two RNs using a checklist and reading off identifying information and blood types and unit numbers yet the wrong blood was still hung not infrequently.  The checklist may be necessary but it is far from sufficient. 
> 
> Michael Kanter, M.D.
> Regional Medical Director of Quality & Clinical Analysis
> (626) 405-5722 (tie line 8+335)
> THRIVE By Getting Regular Exercise
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> 
> From:        Lorri Zipperer <Lorri at ZPM1.COM> 
> To:        IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG 
> Date:        05/01/2013 04:43 PM 
> Subject:        Failing to check all the boxes ... 
> 
> 
> 
> From: Nonie Leonidas [mailto:nonieleonidas68 at gmail.com] 
> Sent: Wednesday, May 01, 2013 5:36 PM
> To: Society to Improve Diagnosis in Medicine; Michael.H.Kanter at kp.org
> Subject: Re: Lack of time, knowledge or just sloppy thinking? ... Failing to check all the boxes ... 
>   
> Hi Micheal, 
>   
> The next time you fly please take the first row, in smaller plane, and watch what the captain and co-pilots are doing. 
>   
> They are minding their checklist, checking them off, and the co-pilot checking it again. 
>   
> When both of them are sure that all of the boxes had been checked-off, that is the only time they will lift-off. 
>   
> And that is the reason why I would fly any day rather than visit a doctor or an ER. 
>   
> Nonie Leonidas 
> Philippines
> 
> On Thursday, May 2, 2013, wrote:
> In my view it is not the checklists per se but also the culture that accompanies the checklist that creates safety and reliability.  Checklists alone do not add all that much value
> 
> 
> 
> Sent with Good (www.good.com)
> 
> 
> 
> -------- Original Message --------
> 
> From :      Alan Morris <Alan.Morris at IMAIL.ORG>
> To : IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> Cc :        
> Sent on : 05/01 07:07:38 AM PDT
> Subject : Re: Lack of time, knowledge or just sloppy thinking?
> 
> If we did this to pilots, no one would fly.
> Paradoxically, we have tools to address this – but virtually no support of interest from funding agencies to pursue development.
> Have  a nice day.
> 
> Alan H. Morris, M.D.
> 
> 
> From:  "Dr.Will" <dr.will at fuse.net>
> Date:  Wednesday, May 1, 2013 7:54 AM
> To:  'Society to Improve Diagnosis in Medicine' <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>, "Alan H. Morris, MD" <alan.morris at imail.org>
> Subject:  RE: Lack of time, knowledge or just sloppy thinking?
> 
> Yes and EMR data entry requirements have exceeded human capability to provide good clinical care (and both eyes and physical contact on patient) in the compressed time allotment by insurance payment and hospital owned productivity requirements. No wonder there are errors in DX and Outcomes.
> 
> If we did this to pilots, there would be more errors, as well. My brother is a retired pilot.
> 
> Will Sawyer, MD
> 
> 
>  
> 
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