Checklist Manifesto by Atul Gawande

Atul Gawande is a name most medical students will recognize. His first two books provided insight into how medicine goes wrong and how we’re working to get better. It seemed there was nothing more to be said at book length, and he’s filled the time with several articles/opinion pieces in print and online. Yet Dr. Gawande was inspired to write twice more.

His third book champions checklists, but its underlying theme is the shift in the power of medicine. Gone is the day of the rock-star surgeon, walking all over the rest of the OR staff and behaving like a petty tyrant. Instead, he deftly weaves the team-as-unit into his discussion, making the argument for a division of power, and sharing of knowledge. After giving examples in construction, commercial flights and finance he champions his cause again, but presents proof in medicine.

His comparison to the master builder is apt, and not limited to the OR. Throughout medicine you will find doctors surrounded by a supporting cast of varying sizes. In the ER the physician leads a team that includes PAs, RNs, LPNs, MAs – and coordinates with triage nurses, paramedics, EMTs, child and elderly protective services and police. In the Family Medicine clinic a team with many of the same members exists, interacting with nursing homes, skilled care facilities, behavioral health professionals, family members and more.

We need those team members, and we need to embrace them as partners in providing care for our staff. Gawande does not suggest that leaders should not lead, but emphasizes the need for all team members to feel comfortable communicating concerns and sharing info to provide the best care for our patients. This not-so-radical idea was an undercurrent at the 2015 AAFP Conference, and is being explored by many medical school curricula.

I would highly recommend this book as must-read early in third year, but I would also caution that it may not be the best topic to open with on day one of your surgery rotation. It may change the way you think, and may help you find your role during each rotation.

“We don’t look for the patterns of our recurrent mistakes or devise and refine potential solutions for them. But  we could, and that is the ultimate point.”

Pixie