Thanks to all so far. A less established angle follows. I've recently started flying (past solo, but not much) and been struck by how badly we do this sort of stuff in medicine. At this stage all I've done in my own practice is to establish proper checklists for some areas where omissions were either frequent, or alternatively unremediable or at least difficult. Just as in aviation there are some things from which you can recover, and other things that you simply can't, and therefore can't let yourself get into.
In terms of the comments about the co-pilot issue I think that the medical culture, at least in australia, is still very hierachical. The "right" of a registrar (advanced trainee specialist: about 4-8 years out) to speak out about a case or a procedure is still not at all accepted (having been there not long ago), despite the fact that more often than not they're in a better position to know than someone who trained 25 years ago, and hasn't retrained since. Now I'm on top there's very poor currency assessment. God knows how we change this culture, because if you're a surgeon, you're GCMG (God calls me God), and physicians (my area) are only marginally better. That's not to say that I entirely believe the propaganda about the spiritual harmony at the pointy end (!), but at least many of the people there believe that they should be trying even if they aren't perfect, because it will actually help outcomes. We medicos haven't got to that point yet where it's accepted that it should be accepted!
Another problem as stated is that error reporting in medicine is suppressed by the design to protect one's own, given that virtually all error is punishable in medicine, and 'there but for the grace of god'....It should also be realised that I pay directly for my colleagues errors, because our insurance funds are collectively based. The short term view therefore is to shut up, especially about lucky escapes as far as any broader reporting goes. In relation to John Farley's comments, don't think that medicine doesn't have bar talk about stuff-ups, I think every profession has its' insiders-only nights, and one actually takes a lot away. However, unlike the aviation safety data, there's no investigation and publication service of these incidents. It's the careful informed examination then dissemination of the knowledge that's the problem. I KNOW as a C150 pilot with ~16 hrs (sad, isn't it, when the last digit's relevant)that the american data for the last 5 years is that what's likely to kill me is fuel exhaustion, accidental IMC, CFIT from inadequate performance (uphill, downdrafts in mountain lees etc), stalling while not paying attention (i.e. overflying your house) or with too much to do (a complicated go around), a fair few midair collisions, not that many engine failures without warning and the occasional one where the word suicide is not actually in the report. Easily less than half would be difficult to avoid (at this level of aviation). Knowing that, I can do something: dipstick or inspect fuel every time (the drag racers siphoning your full tanks overnight made me decide that), get an IR ASAP, etc. It may surprise you that I know all sorts of diseases that can get my patients, and their tests and treatments, but despite 13 odd years since starting I know virtually nothing hard about what are the common causes of error in my field that degrade outcomes.
Enough ranting. To Bill and anybody else, I would very much appreciate it if you could give me an idea of any initial attempts you've made, and any publications of your own or of otheres that you think are especially worthwhile. Links could be posted, or if you have them as a pdf or other file would be welcomed (along with any commments) at
[email protected]
stephen
[ 03 December 2001: Message edited by: go with the flow ]