The Checklist Manifesto (Gawande)

[cahn]

My sister wins. (Actually, she generally wins at life, but that's another story.)

The Checklist Manifesto is one of those books that I have not much to say about, because it is awesome. It is further a book that I think everyone ought to read, especially everyone who has any interest in health care OR complex tasks. Gawande writes very well and he totally won my love by running an experiment and then talking about possible alternate hypotheses that could explain the experimental results. Take that, Gladwell! Oh, it's not rigorous double-blind blah blah, but still! I take what I can get. It is also interesting to translate his central concept into e.g. my job, and how the chief programmer has been dunning "Test jigs! Test jigs!" into all of our heads for several years now -- it really is true, as he says, that all complex jobs use checklists; it changed the way I think about complex jobs by providing a unifying structure for them (I'd never thought to compare Chief Programmer's test-driven-development mantra to erecting a large building, but... Gawande kind of did).

This book did reinforce my distinct impression that medicine is stuck somewhere in the last century, technology-wise. I also feel this way every time I talk to the Kid. This is an actual conversation D and I had with her about her clinical research:

Kid: I like doing the data analysis, I just hate doing data entry.
Me: You know, we could write you a script to make that a lot easier.
D: Yeah, what kind of format is the data in?
Kid: Umm... No, you don't understand...
D and I (nodding sagely): Oh, a propietary format. Well, maybe we could figure out how to export the data you're interested in to a text file and...
Kid: No, I really think you don't understand. The hospital provides us with a printout, and I have to copy the data from that.
D and I: ...????????

...Yeah. Medicine seems to have a lot of fancy machines and robots these days, but they seem not to have grasped the essential lesson of the last two decades being information access.

Comments

[ase.livejournal.com]

Somehow I'm not shocked your kid sister is still getting paper printouts. When I was in high school (more than 10 years ago), one of my aunts worked in a hospital's nursing education department. During summer and winter break in high school, I did some data entry to help her catch up on putting hardcopy continuing education class rosters into the electronic database. There was enough trouble with just that, thanks.

Information in health care is also tangled up with a lot of privacy regulations (HIPAA, GINA) and preventative anti-litigation moves. That's probably not helping any moves toward transparency or easy access.

[charlie-ego.livejournal.com]

My sister gave me that lecture as well -- it's true that HIPAA, etc. complicates matters, and I shouldn't be so flip about "what is wrong with these people??"

That being said... gah! How do they live like that? :)

[ase.livejournal.com]

If only people would take the regulations as a challenge instead of an excuse to drag their heels! But then one remembers the lawyers in the wings.

I failed to mention, having read The Checklist Manifesto, I longed to underline key concepts and mail a copy to certain people in my life.