Month: November 2014

The Checklist Itself Doesn’t Matter

Anyone who understands systems will know immediately that optimizing parts is not a good route to system excellence.…We connect the engine of a Ferrari, the brakes of a Porsche, the suspension of a BMW, the body of a Volvo. What we get, of course, is nothing close to a great car; we get a pile of very expensive junk.” – Chapter 8.

I just finished reading Atul Gawande’s The Checklist Manifesto, which was first published in 2009 and spent some well-deserved time on the New York Times Bestseller List. Written by an attending general surgeon at Brigham & Women’s Hospital in Boston, this book tells the admittedly “unsexy” story of how a simple tool such as a checklist can improve the quality and consistency of outcomes in a wide range of fields: aviation, building construction, venture capital, and (even) medicine. All of these fields are complex systems – involving many moving pieces and players, and an inherent unpredictability of conditions, materials, personnel, and complications. In addition, these arenas assume a certain level of skill and require a high standard of consistency and safety, but errors and complications still plague us. We have reached a point in many fields where the problem isn’t ignorance (we do understand a lot about the world around us) but rather ineptitude (we fail to apply the knowledge that we have consistently and correctly). A checklist can help us improve our “eptitude.”


Medical Students Don’t Learn About Death

The following is part 1 in a series about death and dying in the medical context. This reflection was written by me earlier this year, before I sought out a Palliative Medicine elective. Part 2 will follow soon.


Until the last week of my sub-internship, I had never had a patient die on my watch. To be sure, I had patients on the cusp of dying – and some who did die, of course, when I was already on another rotation. I have been around dying patients who were on our team but were being taken care of by the other resident/medical student. But never a patient of my own, until my final year of medical school.