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Going For The Throat: The Simple Answer to Better Health

Post Published: 20 January 2010
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Category: Column, Health Care Column Thyroid Diseases and Thyroid Cancers
This post currently has 16 responses. Leave a comment

Written by Robyn Davis Hahn, MS DVM

Can a checklist improve your care?

I recently finished a fascinating, well written book that really opened my eyes to how doctors, and humans in general, work in complex settings.   It’s called The Checklist Manifesto, by Dr. Atul Gawande, and it’s his most recently published work.   I had heard Dr. Gawande on an NPR show (two, actually) and felt intrigued and refreshed by the research he had done on improving how doctors work.   There is no way I can distill the information in this book into just a few sentences, but this easy to read, enjoyable tome investigates how extraordinarily easy it is for even the most knowledgeable, most skilled human beings to miss small, yet important and integral steps in complex situations.   Unfortunately, the ultimately result of these errors is often an adverse outcome.   Dr. Gawande goes on to describe how the fields of aviation and sky-scraper construction have evolved to confront this issue, and was challenged to see if the same could improve medical care of patients.   As the title of his book forecasts, the secret is checklists!

Dr. Gawande is quick to point out many of the barriers to widespread checklist acceptance among the medical community.   Among them, the culture of doctors feeling “in charge” of patients, the sheer magnitude of differences in staffing numbers and competency, and the financial conditions of the hospitals to name a few.   Dr. Gawande even admits to having an adjustment period incorporating his checklists into his own practice, and then immediately catalogues multiple small and large mistakes that were averted as a result of their adoption.

This book mainly speaks to issues related to surgical and hospital care, but one can easily envision its application to disease diagnosis.   Imagine if there was a checklist item for every psychiatrist reminding them to look and test for thyroid disease in all new patients before blithely prescribing anti-depressants.   Or if every endocrinologist had to check vitamin D levels off their list when ordering labs for their thyroid patients.   I’m sure we all can think of something simple, easy, that seems to be inconsistently performed at our appointments with our doctors that could make a difference in our collective lives.   For me, I requested that adding freeT3 and freeT4 tests to all lab work be noted in my chart so that even if my doctor and I “forgot” to discuss this at our appointment, I can be sure that it always gets done.

To that end, after reading this book, I decided to try to make a checklist for patients.   What I learned is that this is much easier said than done.   But, I remain undaunted, as it would appear that some of the best checklists in aviation have undergone countless and ongoing revision–so consider this a first draft.   My hope is that the Dear Thyroid community will take this, use it, and give me ideas for improvement.   I used this checklist during my own appointment with my endocrinologist this week and think it is a good start.   The point of the checklist is NOT to include EVERYTHING, rather to include the small, sometimes mundane details that we often forget or are overlooked.   Linked below, the checklist is presented with other helpful tips in red italics, but you’ll also see that the PDF is also available as just the skeleton that can be printed off and put in your purse or wallet.

Robyn

To download and print the below checklists, please log into Google Docs (U: dearthyroiddownloads /P: pass@word)

Short Patient Checklist

Long Patient Checklist

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16 Responses to “Going For The Throat: The Simple Answer to Better Health”

  1. Lolly says:

    Great Article Robyn I was unable to view the checklist on both even though I had signed into Googledoc it is saying “Sorry, the page (or document) you have requested is not available”.

    I think it’s a great Idea and not a new one at that even though I haven;t viewed your checklist yet I learned from a great GD board about having a check list also keeping hard copies of results and a journal of symptoms dosing etc I think everyone should incorporate this in there treatment in order to be able to advocate for your own health care and also know when you feel good and when you don’t and where you feel your best or worse within the set ranges ..and Hey wouldn’t it be just great if they did the Vit D test as par of the course for treating any thyroid disease.

    This also goes for any other medical condition any of may have. I went with a good friend recently who has been undergoing numerous tests still not getting too the bottom of what is wrong, I asked her to keep a daily diary of her symptoms and on her next appointment with the specialist take them with her. one look at those she was referred to a neurologist who suspected Parkinson’s but still isn’t sure there are other underlying issues and each one has to referred to different specialist, so far she has seen maxilla facial who then passed her onto dermatologist who referred her to a Neurologist she is still seeing both of them and more tests to follow, so far they haven’t got a definitive diagnosis but they are doing everything to find one and get to the bottom of it ACE test is high and still rising and this is cause for concern

    Great work hope I get to view your check list

  2. Robyn says:

    Thanks Lolly.
    Kudos to Katie, too, for working hard this morning trying to figure out how to link a PDF.

    Let’s just say, I sorta ASSumed it was easy to just “click” in a link–turns out it’s more complicated than that! I assure you we will continue on it until it works.

    In the meantime, anyone wanting me to send the checklist directly to them can email me at robyn@dearthyroid.org and I’ll do my best to get it to you in a timely fashion.

    Thanks! Robyn

  3. Robyn says:

    Update: I just tried it out, and it worked for me.

    To repeat: click link above, on the right under login, type “dearthyroiddocuments”, and under password, type “pass@word”.

  4. Jen says:

    I think that the problem may be if you have a gmail account. You need to sign out of your gmail account and sign in as dearthyroiddocuments.

    I think that this is a great idea/suggestion! and I’d love to see example lists for different conditions (such as Graves, Hashimotos, Thyca, etc).

  5. Robyn says:

    Hey Jen!
    Thanks for your comment–can you be more specific? Do you mean “line items” specific for the different thyroid diseases?
    It’s a fine line being global enough to include what most docs/patients will encounter, and being so specific that it becomes tedious or begins to have irrelevant line items.
    I also tried to take into account its use for those who have multiple issues/docs, or may not even have a diagnosis. That said, I would love your specific suggestions!!! Thanks again!

  6. Anonthp says:

    I work at a hospital and we have “Protocols” for major diagnoses when patients are admitted. We also have protocols for certain surgical pre- and post-op patients. It makes things easier for the physicians as they just need to check off the items or groups of things that they want to order and it also makes things safer for the patients because then nothing is forgotten. This sounds very similar to what Robyn is discribing. I have to admit that I haven’t yet gone to the site to look at the lists, but I really like the idea and I will use them myself. Thanks Robyn.

  7. Lolly says:

    I still can’t get it even after following your instructions I will send you and email and get the file that way if that is okay.

    Thanks Robyn

  8. Jen says:

    Hi Robyn,
    That’s exactly what I mean. For example, even though I’ve scoured Mary Shomon’s site, among others, I would love a list of the blood tests that I *should* be getting as a Graves Disease patient (on a thryoid blocker) from my endocrinologist. The information is so scattered around the web that I have a hard time figuring out what’s what. I think someone asked a similar question in the forum regarding Hashimoto’s.

    I think that your checklist is an excellent starting point AND has such good reminders about treating our nurses, office staff, and doctors well, with friendly overtures.

  9. Robyn says:

    Jen,
    Thanks for the clarification. I think the reason it’s hard to find out the “right” tests for various conditions is that no one agrees what those are! For instance, my endo thinks reverse T3 is fascinating and interesting, but says there is no clinical research that says it does what its champions say it does. Apparently there are some “test tube” studies, and clinical studies with heart stuff, but not thyroid. So we discussed it and I decided it wasn’t worth testing if it would not change my treatment strategy.
    However, I’ll post a question on the boards regarding what the community here thinks the “standard” tests should be for the various thyroid conditions.

  10. Robyn says:

    Anonthp,
    I’m glad to hear your hospital does this. It’s such a small thing–but it’s the small things that are the easiest to forget, right?

  11. Robyn says:

    Lolly,
    It will be coming your way!

  12. Lolly says:

    Robyn,

    thank you so much it’s a great checklist that everyone should keep save.

    Jen,

    The Lab test you most ceertainly need for Graves disease are Free T3, Free T4 TSH and the antibodiees tests are TSI (Thyroid Stimulating Immunoglobulin and TRab.

    Also it is important before starting any anti thyroid drugs to get a full blood panel done which should include liver enzymes white cell count as they can be out of range due to Graves and not always a result of the Anti thyroid drugs as so many people will have you believe. My Liver enzymes potassium urea Gamma GT and more were all out of range before I started ATD’s..these were kept an eye on and eventually went back to good ranges once the ATD’s had a chance to bring my thyroid levels into a decent range.

  13. Rachelle says:

    Hello Robyn,
    I would love to view your checklist, I’m new to this hypothyroid thing and it is all so complicated…I sent you a message via email as I couldn’t download the checklist from google docs’…

    Thanks for being a much needed resource…

    Rachelle

  14. Kerry says:

    I’m unable to get the checklists as well–hope you don’t mind if I send you an email as well.

    Thanks!

    Kerry

  15. Lori says:

    I was finally able to download them but the program will not allow me to print the PDF file. I wonder if the permission is set to not let someone print? It does say something is corrupt. I have other google docs that I can print but they are not PDF files. Should I forget about trying to get them this way.

    Thanks,
    Lori

  16. Amanda says:

    Thank you for pointing this article out Robyn. I have saved the documents to put with my “take to the doctor” notebooks.

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