Gawande's article "The Checklist" addresses the issue of doctors being required to use a checklist when dealing with patients or in the transition period between patients. The argument is whether or not doctors should be required to use such checklists or whether doing so would be a waste of time and resources in an industry that is already understaffed and low on time. My assertion would be whether or not it is worth the risk to not require doctors to use such a checklist in the hospital. While most doctors would point to their years of training and experience as justification for not needing a checklist, I believe that looking at other professions in which great risk is involved that employ the use of checklists will help add validity to their use in the hospital. What comes to mind immediately for me is astronauts. Astronauts train for almost a decade to do one mission. They know exactly what they are going to do and when they are going to do it. And yet the countdown procedure before take off lasts close to two hours as they check to make sure absolutely everything is in order, even if they know beyond a shadow of a doubt that it is. In this case, the idea of a checklist is being used for the safety of the astronauts and probably also has to do with the monetary investment that has gone into the expedition.
To take the most seemingly harmless example from the article about the checklist, handwashing is something that a lot of doctors and nurses complain that they don't have time for, so having a checklist require them do it would be a waste of time. My assertion is whether or not the risk of infection of a patient is worth that extra few minutes a doctor needs to make sure they are sterile before interacting with a patient, and I for one would say that it is not worth that risk.
Hand washing is something I noticed that is downplayed at the hospital where I volunteered at. At my orientation, they tell the volunteers that after interacting with a patient, we must clean our own hands, but I noticed at the department where I volunteer at, it is something that is something not stressed. Despite the fact that there are many hand sanitizer dispensers scattered throughout the hospital, I do not see them being used often. While I heard about hospital infections, I never realized how prevalent they were until reading Atul Gawande's Better. William is right that the risk of infection is not worth the couple minutes spared by the neglect of clean hands. However, I also notice that especially in the department that I work at, the doctors and nurses are can get so busy that they do not give a second to putting a chart back on the rack. I believe that sometimes health care professionals may think that since they are not sick, hand hygiene is not a top priority to them. They forget that they can be carriers of the disease from one patient to the next, I know I do when I am volunteering at the hospital. I had heard stories of patient care assistants getting a rash because they neglected to put on gloves. Perhaps checklists can help resolve this problem, it makes the system more efficient and Gawande shows how it decreases negative side effects. If more hospitals begin to embrace checklists, this problem of hospital infections and medical errors will become almost nonexistent.
ReplyDeleteIn The Checklist Manifesto, Gawande seems to echo the voices of other authors we've read in the class. He proposes that the enactment of a checklist would alleviate or balance some of the burden that medical professionals carry. Everyday, he explains, the responsibilities of being a doctor increases, with the mounting volume of knowledge and skill that must be maintained. The pace of this increase in complexity of tasks has outstripped the ability of even the most experienced individuals to coordinate them all flawlessly. To illustrate his arguments, he presents numerous anecdotes that guide lay readers through the perspective of doctors in critical and time compressed situations. Gawande further walks the reader through his own process of learning, trying, and accepting use of a checklist, ending with the story of a disastrous operation that was saved only by the existence of one.
ReplyDeleteI wondered whether it was patients that were getting increasingly complicated conditions, or increased expectations of lifespan and quality of life, or simply expanded knowledge that was heightening the difficulties of the medical profession. I agreed with your comment that sometimes for all items on the checklist to be followed, time would be wasted. However, in my opinion, this doesn't mean the checklist itself shouldn't exist, as it may be the protective netting between near-catastrophe and total loss in a critical situation. Doctors can consciously choose to skip steps, but they should still have them as a reference, to be followed in every case.