Going For The Throat: The Simple Answer to Better Health
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 “forgotÃ¢â‚¬ 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.
To download and print the below checklists, please log into Google Docs (U: dearthyroiddownloads /P: pass@word)
Tags: doctor visits, improved health care, patient checklist, patient prep for doctors appointments, Robyn Davis Hahn Health Care Writer, thyroid health, thyroid health care column, thyroid patient checklists