The Checklist Brawl at Brigham and Women’s

I haven’t read the book called  When Doctors Don’t Listen but it was just reviewed in the Boston Globe. Brigham and Women’s Hospital emergency room physicians Dr. Leana Wen and Dr. Joshua Kosowsky state that docs “often tune out a patient’s story when seeking a diagnosis and simply clue in on specific symptoms, which may lead them to over-test and over-treat.”  Yeah, yeah, I have heard that before.   We also don’t let patients speak long enough before interrupting and make a diagnosis before walking into the room.  Guilty.  Is it bad?  Yes, it’s horrible!  The issue is that we are now herding cattle in a system likened to Industrialized Medicine.  The new quality indicators and P4P modules are only making it worse.

Here are some points made in the article:

  • Today’s doctors have failed to practice the art of listening to gain a context in which to place a patient’s symptoms.
  • Wen, who’s completing her residency training, admitted that she, at first, stuck to this form of cookbook medicine — ticking off a checklist of symptoms in her head as a patient spoke — in an effort to become an efficient doctor. “Without realizing it, this became my practice too,” she wrote in the book.
  • Kosowsky, who’s vice chair and clinical director of Brigham’s emergency medical department, called it a “failure in the way doctors are being trained to think,” a result of too much reliance on high-tech imaging tests and blood tests to measure biomarkers that weren’t around a generation ago.
  • “It’s about finding a balance,” he said in an interview. “Neither Leana nor I would say to throw all guidelines out the window, and doctors are well intentioned when they follow these protocols,” Kosowsky said, “but they’ve taken on an oversized role.”
  • In an era that’s ushering in medical checklists to help doctors and nurses avoid transmitting infections or leaving instruments in a patient during surgery, both Wen and Kosowsky told me that while such lists make be fine for improving safety, they shouldn’t be used when making a diagnosis.

So wait a minute, there is an art to medicine?  Cookbook medicine, guidelines, protocols and checklists aren’t everything?  Thinking is important?  Sounds like AUTHENTIC MEDICINE to me.

On a side note, Dr. Atul Gawande wrote The Checklist Manifesto, which argues that we need more checklists that will “bring about striking improvements in a variety of fields, from medicine and disaster recovery to professions and businesses of all kinds.  He is at the same institution as these writers.  Who’s right?  Wonder if there may be a little schoolyard fight going on over at Brigham and Women’s?


28500cookie-checkThe Checklist Brawl at Brigham and Women’s