
So, I got an email the other week from a publisher wondering if I’d like a review copy of Atul Gawande’s new book, “The Checklist Manifesto.”
I responded, “Heck yes”. I LOVE LISTS.
I am a big fan of Gawande’s other two titles, “Better” and “Complications” and was considering investing in his next book. Once it came out on something cheaper than hardcover, of course.
And then it showed up on my doorstep. Hardcover and all. I’ve burned through the chapters in a couple of days, but can tell I will go back and re-read most of it. It’s a simple but inspiring solution to succeeding at highly complex and unpredictable jobs: make a checklist so you don’t miss anything.
“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. And, with it, they have indeed accomplished extraordinary things. Nonetheless, that know-how is often unmanageable. Avoidable failures are common and persistent, not to mentioned demoralizing and frustrating, across many fields — from medicine to finance, business to government.
… the volume and complexity of what we know has exceeded our individual ability to deliver its benefits correctly, safely, or reliably.”
Gawande is a surgeon. And nowhere is this more true than in medicine. In med school we joke that it’s like trying to take a sip of water from a firehose. There is just so much information to memorize. As physicians, you may not need to know tiny details of the glucose degredation enzyme pathway on a daily basis, but there are still a ton of details to manage with an emergency case of DKA in a patient.
Right now, as a student, I’m practicing an established set of checklists that were created by people who studied medicine before me: labs, reviews of systems, medications, allergies, etc. I ask a predetermined set of questions in a history & physical to make sure I don’t miss anything. I check the same CBC and BMP values every morning. Pre-rounds have a different set of questions for a patient with pancreatitis than frostbite. The checklists evolve according to each situation, but I still feel certain things falling through the cracks with my lack of knowledge and experience.
I’m curious to see how the book ends. And I’ll be sure to share the checklist I come up with to help organize my daily 3rd year med student tasks.