Why, then, isn’t the rising cost of malpractice insurance enough to drive acceptance of checklists?
My understanding is that the present (U.S.) system of malpractice lawsuits and insurance doesn’t leave much incentive for extraordinary caution by individual doctors. Once you’ve paid your malpractice insurance, which you have to do in any case, you’re OK as long as your screwups aren’t particularly extreme by the usual standards. Moreover, members of the profession hold their ranks together very tightly, and will give up on you only in cases of extremely reckless misbehavior. They know that unlike their public image, they are in fact mere humans, and any one of them might find himself in the same trouble due to some stupid screwup tomorrow. And to establish a malpractice claim, you need not only be smart enough to figure out that they’ve done something bad to you, but also get expert testimony from distinguished members of the profession to agree with you.
I am not very knowledgeable about this topic, though, so please take this as my impression based on anecdotal data and incomplete exposure to the relevant literature. It would be interesting if someone more knowledgeable is available to comment.
What does it take to overcome an initial low-status perception?
I’d say that in a sense, it’s a collective action problem. The pre-flight checks done by fighter pilots (and even to some extent by ordinary pilots) are perceived as cool-looking rituals, and not a status-lowering activity at all, because these procedures have come to be associated with the jobs of high-status individuals. Similarly, if there was a cool-looking checklist procedure done by those doctors on TV shows, presented as something that is only a necessary overture for acts of brilliance and heroism, and automatically associated with doctors in the popular mind, it would come to be perceived as a cool high-status thing. But as it is, in the present state of affairs, it comes off as a status-lowering imposition on people whose jobs are supposed to be one hundred percent about brilliance and heroism.
Also, there is the problem of the doctor-nurse status disparity. Pilots, despite having much higher status, don’t look down on their mechanics much; after all, they have to literally trust them with their lives. (And it’s similar for other military examples too.) Not so for doctors; it is probably a humiliating experience for them to be effectively supervised and rebuked for errors by nurses. (Again, I’m not an insider in the profession, so this is just my best guess based on the available information.)
How do we even explain such perception in the first place?
The above cited article answers that question almost directly: the idea that typical doctors are doing such a lousy job that they would benefit from a simple checklist to avoid forgetting trivial routine things contradicts the very source of their high status, namely the public perception of them as individuals of extraordinary character and intellectual abilities, completely unlike us ordinary folks who screw things up all the time by stupidly forgetting some simple detail. The author, as I noted earlier, feels the need to disclaim such implications to avoid sounding too radical and offensive. Medicine has been a subject of magical thinking in every human culture, and ours is no exception.
Morendil:
My understanding is that the present (U.S.) system of malpractice lawsuits and insurance doesn’t leave much incentive for extraordinary caution by individual doctors. Once you’ve paid your malpractice insurance, which you have to do in any case, you’re OK as long as your screwups aren’t particularly extreme by the usual standards. Moreover, members of the profession hold their ranks together very tightly, and will give up on you only in cases of extremely reckless misbehavior. They know that unlike their public image, they are in fact mere humans, and any one of them might find himself in the same trouble due to some stupid screwup tomorrow. And to establish a malpractice claim, you need not only be smart enough to figure out that they’ve done something bad to you, but also get expert testimony from distinguished members of the profession to agree with you.
I am not very knowledgeable about this topic, though, so please take this as my impression based on anecdotal data and incomplete exposure to the relevant literature. It would be interesting if someone more knowledgeable is available to comment.
I’d say that in a sense, it’s a collective action problem. The pre-flight checks done by fighter pilots (and even to some extent by ordinary pilots) are perceived as cool-looking rituals, and not a status-lowering activity at all, because these procedures have come to be associated with the jobs of high-status individuals. Similarly, if there was a cool-looking checklist procedure done by those doctors on TV shows, presented as something that is only a necessary overture for acts of brilliance and heroism, and automatically associated with doctors in the popular mind, it would come to be perceived as a cool high-status thing. But as it is, in the present state of affairs, it comes off as a status-lowering imposition on people whose jobs are supposed to be one hundred percent about brilliance and heroism.
Also, there is the problem of the doctor-nurse status disparity. Pilots, despite having much higher status, don’t look down on their mechanics much; after all, they have to literally trust them with their lives. (And it’s similar for other military examples too.) Not so for doctors; it is probably a humiliating experience for them to be effectively supervised and rebuked for errors by nurses. (Again, I’m not an insider in the profession, so this is just my best guess based on the available information.)
The above cited article answers that question almost directly: the idea that typical doctors are doing such a lousy job that they would benefit from a simple checklist to avoid forgetting trivial routine things contradicts the very source of their high status, namely the public perception of them as individuals of extraordinary character and intellectual abilities, completely unlike us ordinary folks who screw things up all the time by stupidly forgetting some simple detail. The author, as I noted earlier, feels the need to disclaim such implications to avoid sounding too radical and offensive. Medicine has been a subject of magical thinking in every human culture, and ours is no exception.