Thanks Dr. Wachter,

when I was teaching my law & medicine students and the inevitable issue of patient safety and “jumbo jet/day” presented – that you wisely alluded to, I would ask the students to consider an axiom from my redneck car racing days . . . “speed costs money, just tell me how fast you want to go.”

In other words, we can have a “100% safe” health care system. It’s just going to cost much more than anyone can afford, both in actual $$ and in the time required to spend on every patient. I can practice essentially error-free medicine if I am seeing four patients per day. I can complete all the JACHO-required questionnaires on firearms, seat belts, med allergies, vaccinations, “safe at home,” CAGE profiles, also while administering smoking cessation and diabetic teaching. I can query patients multiple times per visit on their wong-baker faces and use a clunky EMR to document a 37 page encounter for a level III E&M visit.

This will make the hospital attorneys beam with pride, the nursing supervisors ecstatic, but rather quickly the hospital administrator will be fired because revenues will dry up, and the 127 patients still sitting in the ER waiting room will being rioting in anger because they had to wait 17 hours for their kid to be evaluated for a “cold.”

Just tell me how fast you want me to go . . .

When EHRs go down, no one investigates; and no one investigates the other errors, deaths, and injuries.

Hello?

There is EHR anarchy in most hospitals.

“just do not make the doctor touch it except to sign something important.”

Like your billing statement?

Bob. If you interview doctors who are also pilots you will learn the universe of medical practice is vastly larger than the universe of aviation.

The alarms on everything were created by people who become alarmed easily. One commonly used ubiquitous piece of equipment audibly and loudly alarms just because it was turned on! Alarm fatigue is real.

The best piece of automation in medicine is the digital x-ray system. The worst is the EMR.

I serve the EMR. It does not serve either the patient or me, the doctor. A total waste of time. I am not knocking the computer…just do not make the doctor touch it except to sign something important.

But I can tell you that the time I spent with Sully, and the day I spent with Boeing engineers who are responsible for their cockpit design, were some of the most instructive experiences I had in writing my book. Not that designing a computer system for a cockpit is the same as designing an EHR — they’re wildly different — but the embedded philosophy of user-centered design in the aviation industry was a far cry from what I saw when I spoke to several IT vendors.

As one vivid example, when I told Sully and the Boeing folks about the volume of alerts the average clinician sees in a day (not only CPOE alerts by bedside alarms in the ICU), they were flabbergasted. We need to embrace some of these lessons in healthcare if we’re going to get it right.

I agree with Dr. Roboto,

Dr. Sullenberger is a true American hero and deserves all the accolades and praise due him.

But I too am “weary of our endless cross-industry comparisons.” Yes, flying is inherently a dangerous endeavor. So is cutting open a human and taking out the diseased parts.

There are many differences (and pitfalls) in comparing medicine and aviation. One of the most striking is that with aviation, you start with a perfectly good airplane, check the weather, wind, elevation, takeoff weight, etc., and fly from point A to point B. If something goes wrong, either something broke (which means error in making the part, or maintaining the part), or it’s “pilot error.”

In medicine we don’t get to start with a perfectly good airplane. We get to play the hand we are dealt, e.g., 76 y/o smoker with renal insufficiency, diabetes, CHF with ejection fraction of 25%, liver disease, on steroids for chronic arthritis, comes in the door of ER with an upper GI bleed, systolic BP 80/palp.

If this guy dies, is it because of “doctor error”?? What “systems changes” to our hospital, our ER operations, our medical training, etc. will make him survive? This is not a function of simply applying enough technology and double/triple/quadruple checking everything to insure a “safe” encounter for this patient.

Now if the doctor asks for vancomycin and the nurse administers vibramycin, then ok, we have a problem that might be amenable to such “system change.” But until Boeing and Airbus start manufacturing humans, AND have control of their myriad self-destructing behaviors, then I think the comparison is going to continue to fall short.