I know I’m late to the game, but I’m finally reading Atul Gawande’s 2002 book Complications: A Surgeon’s Notes on an Imperfect Science. I’m about a quarter of the way through the book, and it’s obvious where much of the inspiration and the groundwork for his later book Checklist Manifesto came. Gawande dedicates a section to errors in medicine and – much like many who have come before and after him – points to other “high reliability industries” to show that errors occur but can be minimized. In 2019, we are still debating that central tenet in medicine, albeit there are few who disagree now than there were when Gawande wrote this book. Yet there are still people, physicians in particular, who point out that checklists, protocols, formulas, and equations cannot account for every possibility given how complex medicine and patients are. These same individuals will point to “intuition” and “the art of medicine” as the bedrocks of diagnosis and treatment. To those individuals, I steal a quote from Gawande,
Of course, patients are far more complicated and idiosyncratic than airplanes, and medicine isn’t a matter of delivering a fixed product or even a catalogue of products; it may well be more complex than just about any other field of human endeavor. Yet everything we’ve learned in the past two decades – from cognitive psychology, from ‘human factors’ engineering, from studies of disasters like Three Mile Island and Bhopal – has yielded the same insights: not only do human beings err, but they err frequently and in predictable, patterned ways. And systems that do not adjust for these realities can end up exacerbating rather than eliminating errors.
Adverse medical events are believed to kill between 250,000 to 400,000 people each year, making it the 3rd leading cause of death in the United States. The real question then is, when can we finally put this debate to rest? When can we finally wrap our heads around the idea that there are far better and safer ways to deliver care than “intuition”?