|LETTER TO EDITOR
|Year : 2016 | Volume
| Issue : 2 | Page : 132-133
DPS R. K. Puram, New Delhi, India
|Date of Web Publication||7-Oct-2016|
DPS R. K. Puram, New Delhi
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Singh M. The Checklist. J Pract Cardiovasc Sci 2016;2:132-3
In any moment of decision, the best thing you can do is the right thing, the next best thing is the wrong thing, and the worst thing you can do is nothing.
With a book like “The Checklist Manifesto” one would think that Atul Gawande is another writer in the ocean, trying to tell us the age-old story of the “to do list” that we all dread. What you find instead is a book on what it takes to be a successful doctor. The Checklist Manifesto is a welcome voice of reason in a chaotic medical world.
The vastness and complexity of medical knowledge today have exceeded any single doctor's ability to manage it and remember it all the same consistently without error. He has beautifully depicted how checklists which may seem like an extremely simple concept, in an exceedingly complex world, do actually work.
From something as basic as a grocery list to the lists used in the commercial aviation industry, we need to draw back our attention at the grass roots level and realize how complicated our lives would be without the so called “to do list.”
| the Question Is, Do We Really Need a Checklist in the Arena of Medicine?|| |
The answer can be found in the article below, reported by the Times of India.
A hospital in Delhi sacked two orthopedic surgeons, two nurses, and an operation theater technician for operating on the wrong foot of a 24-year-old youth.
The patient had fractured his right foot when he slipped on a staircase. The doctors put multiple screws inside the left foot instead. Ravi's family said they even tried to brush it off initially as a mistake.
“The doctors said surgery was needed to fix the bones. We agreed but wanted some time to arrange the insurance papers. So a temporary cast was put. It's incomprehensible how they missed the marks left by the cast and operated on the wrong foot. It is a case of medical negligence, and the doctors must be punished suitably for this,” said the patient's father.
He added that when the patient came to his senses, he screamed about the wrong surgery, and that's how the doctors realized their error.
There are enough evidences to support that, doctors who are extremely educated and experienced in their areas of expertise, being too indulged in the abstract of medicine, often miss out on some very basic ideas, bringing out some unintended consequences. Human memory makes us let go of points that hardly matter until 1 day they do!
Medical care in the 21st century is highly advanced, and it routinely saves patients, who just a few years ago would have faced certain death.
Inspite of this, a number of patients still die due to basic human errors such as someone forgetting to wash their hands and an infection taking hold with fatal consequences, if a checklist is followed, these can be done away with.
The World Health Organization estimates that there are now more than 13,000 different diseases and syndromes. For most, science has provided solutions - either curative or palliative. The challenge is for each condition, the treatment steps are different and often complex. The average clinician has thousands of drugs, guidelines, and procedures to choose from. This is difficult even for the best.
The problem here is rather dramatic for a country like India with a population of 1.27 billion and counting. Every single household has at least one family member who needs to see a doctor, given the scarcity of doctors tackling an enormous population, mistakes are inevitable. A checklist might effectively be the solution to this ever increasing chaos.
Gawande explains how breaking down complex tasks into small steps can improve everything from airline safety to heart surgery survival rates. The Checklist Manifesto shows how a simple idea can transform how we operate in almost any field and improve upon our skills.
“Here, then, is our situation at the start of the 21st century: we have accumulated stupendous know-how. We have put it in the hands of some of the most highly trained, highly skilled, and hardworking people in our society. Moreover, with it, they have accomplished extraordinary things. Nonetheless, that know-how is often unmanageable. Avoidable failures are common and persistent, not to mention demoralizing and frustrating, across many fields - from medicine to finance, business to government. Moreover, the reason is increasingly evident: the volume and complexity of what we know have exceeded our individual ability to deliver its benefits correctly, safely, or reliably. Knowledge has both saved us and burdened us. That means we need a different strategy for overcoming failure, one that builds on experience and takes advantage of the knowledge people have but somehow also makes up for our human inadequacies. Moreover, there is such a strategy - though it will seem almost ridiculous in its simplicity, maybe even crazy to those of us who have spent years carefully developing ever more advanced skills and technologies. It is a checklist.”