Checklists & protocols: Doctors’ egos versus patients’ lives (and taxpayers’ dollars)

Three clips from different things I’ve read (relatively) recently, all saying doctors’ egos and status-fights can kill (and more).

First up, Atul Gawande, who has also written “Better: A Surgeon’s notes on Performance.

“We don’t like checklists. They can be painstaking. They’re not much fun. But I don’t think the issue here is mere laziness. There’s something deeper, more visceral going on when people walk away not only from saving lives but from making money. It somehow feels beneath us to use a checklist, an embarrassment. It runs counter to deeply held beliefs about how the truly great among us – those we aspire to be – handle situation of high stakes and complexity. The truly great are daring. They improvise. They do not have protocols and checklists.
Maybe our idea of heroism needs updating.”
Page 173 Atul Gawande Checklist Manifesto

Then there’s this from “Vital Signs” by an Aussie ICU doctor called Ken Hillman. The whole book is full of quote-worthy and blog-worthy snippets…

“The concept of the standardised approach was developed by an American surgeon, James Styner. Styner had been injured in the crash of a light plane he was piloting. His wife and four children had been passengers. His wife died as a result of severe injuries and his children were also severely injured. He was subject to the old system – disjointed, with the wrong people delivering care at the wrong time. When he recovered, he made it his life’s mission to develop a system based on teamwork, and prioritised care according to tried and tested protocols. This is hard for doctors. They are trained to be individuals, not team players, and protocols are sometimes seen as mindless constraints, necessary for lesser beings such as paramedics and nurses; people who are not trained to think, analyse and lead.”
Page 230 of Ken Hillman, Vital Signs

And finally, from Malcolm Gladwell‘s “Blink”

“He [Brendan Reilly, the chairman of the Cook County Hospital Department of Medicine] took Goldman’s algorithm, presented it to the doctors in the Cook County ED and the doctors in the Department of Medicine and announced that he was holding a bakeoff. For the first few months, the staff would use their own judgment in evaluating chest pain, the way they always had. Then they would use Goldman’s algorithm and the diagnosis and outcome of every patient treated under the two systems would be compared. For two years, data were collected, and in the end, the result wasn’t even close. Goldman’s rule won hands down in two directions: it was a whopping 70 percent better than the old method at recognizing the patients who weren’t actually having a heart attack. At the same time, it was safer…
page 135


About dwighttowers

Below the surface...
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One Response to Checklists & protocols: Doctors’ egos versus patients’ lives (and taxpayers’ dollars)

  1. mike k says:

    Hubris kills.

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