Can a checklist elicit collaboration and creativity in diagnosis?

Peggy Zuckerman peggyzuckerman at GMAIL.COM
Fri May 3 14:15:25 UTC 2013

Really doing a little training here for us, as per Lorri's request.  The
thread has shifted a bit, so a new subject in in order.

Peggy Zuckerman

*Sent:* Thursday, May 02, 2013 11:09 PM
*To:* Society to Improve Diagnosis in Medicine; Norman, Geoff
*Subject:* Re: Failing to check all the boxes ...

 So how do you measure quality in the receipt of health care?  In effect,
you have said that there are no basic guidelines, even if those guidelines
are inadequate to cover all the possibilities.  The natural conclusion is
that you have to hope that the doctor will "guess" right more often than
not.  And that may be the reality...but is there no way to improve those
odds by learning and using the steps and approaches that elicit improved

Peggy Zuckerman

 On Thu, May 2, 2013 at 5:17 PM, Norman, Geoff <norman at> wrote:

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

 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.


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


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

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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