Hey patients, checklists are okay.

“Back before 9/11 when I would fly to Chicago on Air Wisconsin’s small aircraft, the door to the cockpit was often wide open. We passengers could see the pilot and copilot consult their checklists prior to takeoff and landing. I’ve even watched the pilot’s radar as he flew around a thunderstorm.”

“I presume you had no reservations about their using checklists, did you Curmudge?”

“None whatsoever, Jaded Julie. That’s the way things were done on commercial flights; they are still done that way except we can’t see it through closed and locked cockpit doors. Everyone understands that checklists enhance flight safety by ensuring that no critical steps are overlooked.”

“By now everyone working in health care should be aware of the evidence showing that checklists used in medicine achieve the same goals as those used in aviation. Our checklists enhance patient safety.”

“The articles that I have seen appear to be directed at physicians, and their most common objective is to increase checklist use. Gawande’s The Checklist Manifesto (1) is written for a general audience, but I suspect that most copies are purchased by people within health care. Patients in general may not be used to checklists in medicine.”

“After he is induced, a patient in the OR won’t know if a checklist is used, and a patient in intensive care is probably too sick to care. However in other areas patients might have reservations about a physician consulting a checklist. In fact, other physicians might feel the same way. This could lead to reluctance by physicians to use them. Curmudge, I’m concerned.”

“The same could be said about clinical decision support systems, Julie. It’s hard to envision a physician leaving the patient in the exam room to go back to his office to consult Isabel on his computer. He should be able to do it right there.”

“And the solution is…”

“Improved physician-patient communication and perhaps even a changed culture among physicians and patients. The physician will need to help the patient to understand that better outcomes result when the physician uses evidence-based protocols, checklists, and decision support systems. Patients already accept the physician’s consulting his PDR to ascertain the correct dosage of a medication. These other tools are simply the next step in providing better patient care.”

“That ought to fly, Curmudge, especially as patients become more knowledgeable and more involved participants in their own care.”

Affinity’s Kaizen Curmudgeon

(1) Gawande, Atul The Checklist Manifesto: How to Get Things Right (2010, Available through Amazon.com.)