As if on cue… (Checklists, round 2)

Yesterday, I wrote about an absolute must-read book: The Checklist Manifesto: How to Get Things Right

It has been shown in an extensive world-wide study that a simple checklist used in surgery cuts infection rates, cuts death rates, and saves costs. It does all of these by substantial margins, everywhere they’ve been implemented. But so far only a minority of hospitals (Dr. Gawande mentioned 10 percent) have started using the safe surgery checklist, or any others, for that matter.

Yet today, the New York Times has an article titled “Results Unproven, Robotic Surgery Wins Converts.” Here are the most important quotes:

But robot-assisted prostate surgery costs more — about $1,500 to $2,000 more per patient. And it is not clear whether its outcomes are better, worse or the same.


Last year, 73,000 American men — 86 percent of the 85,000 who had prostate cancer surgery — had robot-assisted operations, according to the robot’s maker, Intuitive Surgical, the only official source of such data. Eight years ago there were fewer than 5,000, Intuitive says.


[O]nce a hospital invests in a robot — $1.39 million for the machine and $140,000 a year for the service contract, according to Intuitive — it has an incentive to use it. Doctors and patients become passionate advocates, assuming that newer means better.


And the robot is slow; it typically takes three and a half hours for a prostate operation, according to Intuitive, twice as long as traditional surgery.

So in this particular kind of surgery, a majority of surgeons quickly take up a new technology that has yet to show it can provide any sort of benefit! The same procedure is now slower and much more expensive. And the same doctors are resisting adopting a simple checklist (for little to no cost) that conclusively show improved results.

Not to make too much of a political situation here, but our health care system is clearly a mess. Doctors clearly don’t always know what’s truly important for their patients. I’m not saying surgeons shouldn’t use robots, but exhaust the easy, cheap, and conclusively better tools first! Use a damn checklist!

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