Checklists Aren’t Just For Clinicians

Checklists – lists of requirements for completing tasks without errors or omissions – are common in many industries. Aviation, software engineering, litigation, manufacturing all rely on the use of checklists to accomplish their objectives – no crashes, no bugs, no missing evidence, no missing parts.

When Atul Gawande’s bestselling book “The Checklist Manifesto” landed in 2009, it was interesting to observe the reaction to it from the medical community. There was a visible divide between the old guard (clinicians trained under the eminence based medicine rubric) and the new crop of medical professionals who trained as the web made information more widely available to the average human. The BMJ has a tongue in cheek article, “Seven alternatives to evidence based medicine,” that is a checklist of a sort to figure out which type of clinician you’re working with.

Checklists are a necessary part of completing any complex task, including the practice of medicine. Resistance to “cookbook medicine” – seen as overly rigid adherence to practice guidelines versus clinical judgement in individual patient care – was noticeable from the eminence based bunch in the wake of “The Checklist Manifesto” landing on bestseller lists a decade ago.

Here’s the thing – checklists aren’t just for the clinical side of the stethoscope. Anyone can play, most particularly those of us who are on the receiving end of medical care.

You can start with some of the existing checklists created by patient safety organizations like the National Patient Safety Foundation’s “Ask Me 3” list:

  1. What is my main problem?
  2. What do I need to do?
  3. Why is it important for me to do this?

If you want a deep dive, you can pick up a copy of “The Patient’s Checklist” by Elizabeth Bailey, a professional patient advocate with years of experience, both personal and professional, in managing complex medical treatment.

I’ve built a few checklists of my own, one called the Must Ask List, and one called (wait for it) The Checklist, that are part of my ongoing work on building better communication tools for people to use with the clinical care teams that help them get, and stay, healthy.

In my very-recent patient experience getting a bionic knee – the new guy’s been in place for three weeks as I write this – I worked a checklist that had me searching ProPublica’s Surgeon Scorecard for the orthopedic surgeon in my metro area with the highest number of total knee replacement procedures who also had a low complication rate. The Surgeon Scorecard isn’t exhaustive, it only covers eight common surgeries, but it’s a great starting point if you’re in need of one of those eight procedures.

I also worked my local network of friends who I knew had had knee replacements, and those who had been patients of the guy I’d identified via Surgeon Scorecard as El Numero Uno in total knee replacement on the expertise/outcome metric I used uniformly praised his approach, his staff, and their individual outcomes.

The process I just described is … working a checklist. Anyone can build and run a checklist while they’re dealing with a medical issue. Using any of the examples I’ve shared here can get you started. And ask your medical care team what checklists they’re using – maybe you can adapt them for your own use.