The Checklist and Simple Rules @ BYOB Party in Sep 2018 (Part 4)

Image result for the checklist amazonAalok got two books, both by the same author- Atul Gawande, a renowned Indian origin American physician. We’ve talked about his books at the BYOB Party before. In spite of all the advances in medicine, there is still room for error and this can be easily avoided, says Gawande in his book The Checklist Manifesto. How? By following a simple tool like a checklist, a method used by people employed in industries as distant from medicine as construction. Many small cautionary steps could make the difference between life and death – hand washing, taking a tally of the instruments and something as simple as having the team members introduce themselves could improve productivity in hospitals. Hospital tales followed about how tiny omissions wreaked havoc post-surgery and skewed patient-doctor ratios led to the checklist implementation having failed in India.

Image result for being mortal amazonThe other book he talked about was Being Mortal which deals with how a doctor’s and caregiver’s role is not only to extend lives but provide a meaningful extension of life. Quality of life is often ignored in an attempt to save the patient and the soul is quashed. While making life decisions, the patient should be consulted as well if indeed it can be done. So while one patient may be emotionally ready to undergo a risky surgery that could leave him paraplegic, another patient may not feel the same way? So what is the next best option? We see this kind of discussion even in Paul Kalanithi’s When Breath Becomes Air when the husband and wife in the book discuss important choices. An inevitable death is no excuse to avoid dialogue. However painful, these conversations that the doctor has with the patient and the patient has with her caregivers can alter the final moments of a patient’s life.

Image result for simple rulesamazonA question arose about whether human error that could be countered with a checklist only meant that medicine was better off with more automation but Deepak countered this argument with the book Simple Rules by Kathy and Sull, Donald Eisenhardt. The environment that Gawande talked about had unstructured complexity, so in such a case manual feedback is essential and mere automation and algorithms will not do.  Deepak mentioned various real-time situations and talked about simulations of schools of fish to throw light on how to navigate complexities in the world by adhering to a few simple rules. Go to this link to understand more about Simple Rules.


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