Saturday, January 9, 2010

Physician Regulation - More on Checklists

Prelude: This is a follow-up on my last blog. It is from another doctor’s blog, Medical Rants, dated January 9, and is entitled “Processes of Care: Lessons from Gawande and Saban.

"Readers know that I live in Alabama. We are all aglow after the big win Thursday night. The coach of the Crimson Tide is known as a grinder. In almost every press conference he emphasizes the importance of playing the right way. He worries more about process, and believes that with good process one achieves good results. His teams do not turn the ball over and they do not commit penalties."

"Process is important for many aspects of health care delivery. Process is not the only important issue, but for some things process makes a huge difference in health care safety."

"I am currently reading Atul Gawande's book – The Checklist Manifesto. This book extends a wonderful article from The New Yorker – "The Checklist,"

"This article starts with Peter Provonost's wonderful study showing that paying attention to details markedly decreases central line infections. He achieved success by requiring a checklist of 5 steps prior to placing the central line. His checklist keeps physicians and nurses from skipping steps. Skipping steps leads to increased infections."

"In reading the book, I am thinking as one who does not do procedures. We internists consider ourselves cognitive physicians. Now I must note that those who do procedures are also thinking. They do procedures and thinking. We internists who do not do procedures rely on our cerebrum and literature searches. So how can a checklist help us?"

"I actually use checkilsts in my teaching. In caring for diabetics I teach the FLECKS. When I teach about myocardial infarction patients, I discuss the 4-pack – anticoagulation, beta blocker, statin and ACE inhibitors. At discharge, unless contraindicated, patients should have at least one medication from each of these classes. I use checklists for diagnosing increased anion gap acidosis, hypercalcemia, hyponatremia … You get the idea."

"We should identify those situations in medicine helped by remembering and using checklists."

"If he understood medicine, Nick Saban would relate well to this rant. He always stresses dotting the i's and crossing the t's. As Gawande teaches us, we should take advantage of this simple solution to the frailties of memory."

Dr. Richard Reece is author, blogger, speaker, and innovation and reform commentator. Dr. Reece’s latest book, Obama, Doctors, and Health Reform ( is available at www.iuniverse and other book websites .. For information on speaking fees and arrangements, call 860-395-1501.


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