Atul Gawande is sort of a rock star in the medical world. A general surgeon who specializes in endocrine tumors at Brigham and Women’s in Boston, he became a staff writer for the New Yorker while still doing his surgery residency. He was a Rhodes scholar and a 2006 MacArthur fellow. He has written three books, all of which I’ve read and all of which are excellent. The first two (Better and Complications) were musings on medicine, and how we as doctors can improve.
Gawande has become a well-known writer on health policy and systems and something of an expert on safety. The Checklist Manifesto is partly about how he led a team to develop a surgical safety checklist for the WHO. This part alone is fascinating, both as a physician and I would imagine for anyone.
However, what really makes this book interesting is that Gawande looks at the use of the simple checklist in a multitude of fields: construction, aviation, finance and even a four star restaurant. He draws lessons from such wide examples as Walmart’s role in relief efforts after Hurricane Katrina and David Lee Roth’s requirements for pre-concert backstage preparations. He argues that in the modern world most of our jobs are becoming increasingly complicated and complex. He shows that usually the mistakes we make as experts aren’t due to ignorance (not knowing what to do) but ineptitude (knowing what to do but forgetting to do it). He demonstrates how a simple checklist can make a difference in decreasing those types of errors in a complex world.
I have to admit that as a doctor part of me rebels against this idea. Gawande says
We don’t like checklists. They can be painstaking. They’re not much fun….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 situations of high stakes and complexity. The truly great are daring. They improvise. They do not have protocols and checklists.
I think most doctors would agree with this. I found arguments coming to mind as I read the book like “Yes, but each patient is different,” and “A checklist doesn’t leave room for that gut feeling, for experience,” and “I can see how this would work in a specific setting like surgical safety but not for the day-to-day life of a pediatrician.”
But then as I read more I started to wonder. I started to think off all the ways I have used checklists in medicine even if I don’t call them that. For example, when doing a physical exam I always do it in the exact same order. That way I don’t miss something. I started to think about how I might be able to incorporate some of Gawande’s ideas into my daily practice. I’m still mulling that over, but it’s given me a lot to think about.
This is a really beautifully written book. It’s interesting and even fun to read. It’s very Gladwellian in both subject and style. I would highly recommend it to anyone, in the medical field or not.