The Checklist Manifesto -- Life Application

Atul Gawande first caught my attention as in an article for The Best American Science and Nature Writing 2009 called The Itch, aptly titled because it explores the underlayers of our human need to scratch beautifully. He effectively communicates along the lines of American Plain Speech, almost eliminating the intimidation of  medical jargon to the uninitiated. His newest book, The Checklist Manifesto, was a revelation, not in that it's a superb literary work, but that it points out an obvious lacking in fields of ever-growing complexity, with medicine in particular. The theory is based on the pilot's checklist, developed extensively by Boeing after a failed test of their B-17 Bomber killed 2 crewmembers due to a procedural oversight.

The basic gist is that no matter how many decades of training an ultra-specialized surgeon has undergone, the dumbest things can escape notice which can prove either mildly harmful or life-threatening for the poor sap strapped to the table. Things like making sure your operating on the right patient, even doing the right procedure, a missing sponge, and so on. Just read the book if you're dying to know more. If you're even vaguely fascinated by the notion of how more people die due to infection contracted in hospital procedures than car-crash fatalities in America, this will be worthwhile.

It's not shock that first interested me in the subject, but how closely in line it is with my own profession and how much I take such a thing for granted. In aviation maintenance, we call it pre-operational checks. From the simple task of making sure a maintenance platform lifts up correctly and relieves pressure at the right rate of descent to the more complicated actions of ensuring the fault unit on a turbine engine displays the proper sequence code for normal operation. Then there's the "stupid" checks we Sailors do during maintenance around the ship, like making sure a toilet fully flushes in under 6 seconds.

It never occurred to me how labors requiring intensive skill and knowledge are done. I take my work checklists to heart and that's my world. The tow tractor isn't starting? Look up the troubleshooting table. Says check battery. Replace. Awesome, it works.  It's such a simple solution. A checklist like your shopping list. Only for surgery. I do get a tickle out of realizing this is widely implemented throughout the Navy to the point that in causing a Sailor's brains to turn to mush, it's second only to death by PowerPoint. It's a bit overdone though, I've worked with checklists that say "#7 Check coolant. Refer to Publication XYZ. Follow steps a-e to determine specific gravity. Seriously? A checklist within a checklist? We often joke about it in the Navy, saying there's probably a publication that tells us how to wipe our backsides. But I wouldn't be surprised if there was. Though I am surprised that surgeons don't have one.