

Why do we regulate driving more than some medical procedures? - yummyfajitas
http://www.overcomingbias.com/2010/07/catheter-infection-law.html

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russell
The problem is that it is doctors everywhere in the chain. Doctors ignore the
best practices, so they arent going to enforce the same on nurses. Doctors
review doctors so the same problems again. Hospitals dont want the costs of
gowns, etc. For insurance companies, the cost of the deaths is probably less
than the cost of the additional materials.Medical procedures are unregulated
as opposed to equipment and drugs. Nobody has a charter for best practices.
It's not even in the group think.

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adamilardi
[http://www.amazon.com/Checklist-Manifesto-How-Things-
Right/d...](http://www.amazon.com/Checklist-Manifesto-How-Things-
Right/dp/0805091742)

This is a book on the topic you brought up. Doctor's have too much ego to
follow a checklist. It doesn't make sense however since extremely smart people
in the military and nasa follow checklists all the time.

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yock
It isn't a matter of intelligence but rather of culture. Most of what occurs
in a hospital is seen as an exercise in problem solving. Applying rote
knowledge and experience to a patient's current situation and making decisions
about his or her care. Most of the culture highly values memorization as well.
It is seen as a demonstration of proficiency. There is some legitimacy to
this, as demonstrating the ability to memorize a procedure that is not time-
critical often indicates an ability to memorize those that are. Consider an
arresting patient who desperately needs venus access for life-saving
medication. Consulting a checklist in such a situation means seconds lost, and
seconds often make huge differences in survivability.

It just isn't as simple as looking at other industries and seeing success,
then applying it to another industry expecting similar outcomes. The people,
procedures, environments, and attitudes are all vastly different.

~~~
adamilardi
I think you're confusing the split second decision making required during a
surgical emergency and the simple steps they need to take before starting to
prevent infection and common issues. Such as making sure everyone washed their
hands, correct dressings are used, having the right medication available for
the procedure etc. It should be don't start this procedure until all the
checks are ticked. Just like a pilot doesn't take off before he's done with
his checklist. Personally I'd rather my surgeon go through a checklist of 20
things before operating on me than trying to remember them.

~~~
yock
I think perhaps I wasn't clear. I don't disagree that checklists aren't a
great tool in an environment less sensitive to time constraints, rather, I
believe that the culture of the healthcare industry is one of constantly being
prepared for time constraints. Healthcare professionals tend to apply the same
procedures in both critical and non-critical circumstances, and I think there
is some legitimacy to that

Imagine the nurse who spends her entire shift insertting IVs. Now imagine that
she grows accustomed to working off a checklist everytime. Day in and day out
she operates with a checklist for weeks and months on-end. Suddenly, a patient
goes critical on her shift and she has seconds to insert a life-saving IV for
fluids and medication. Can she operate efficiently without a checklist? I
suspect the answer to that question is a resounding "no" and that her
patient's life suffers as a result.

The situation isn't as cut and dry as I'm making it, that's for sure. No doubt
there is incompetency and complacency all throughout the industry, and
checklists could probably combat that effectively. I just think that mandating
their use across the board in every circumstance will have unintended
consequences that may very well cost lives.

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adamilardi
So far the research has shown that it does save more lives than it would hurt.
" Suddenly, a patient goes critical on her shift and she has seconds to insert
a life-saving IV for fluids and medication. Can she operate efficiently
without a checklist? I suspect the answer to that question is a resounding
"no" and that her patient's life suffers as a result."

The point of the checklist is not to replace knowledge it's to prevent stupid
mistakes. The nurse should know how to do these things without the checklist.
The only reason it's there is to prevent laziness and forgetfulness. It's easy
to forget one step out of x when you do it all day. I'd even say the checklist
would make him/her better in an emergency because they are conditioned to do
the same thing over and over. Like a ninja master!

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Semiapies
The addendum is key. It's somewhat harder to find examples of attempts to
prosecute safe driving.

But then, trying to portray _medicine_ as wildly unregulated should make
anyone who's spent much time in or or worked in a hospital, regardless of
political persuasion, laugh eir _asses_ off.

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Tichy
Can't you sue if doctors mess you up? (I don't know, at least not in this
case...).

~~~
neurotech1
The key would be proving negligence. Just because a catheter infection occurs,
doesn't mean the doctor/nurse/hospital is negligent.

~~~
indrax
Especially since part of negligence is the standard of care.

As long as everybody's not-doing it, it's not a liability.

[http://en.wikipedia.org/wiki/Medical_malpractice#Elements_of...](http://en.wikipedia.org/wiki/Medical_malpractice#Elements_of_the_case)

I am not a lawyer, but I was briefly an EMT.

