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Comment by mariodiana | Hacker News Reader

Gawande's essay (and book) on the subject came up just recently in discussion on Hacker News. What it all boils down to is that the medical profession in hierarchical and conservative: doctors don't want to change and don't want anybody telling them what to do.

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So was the piloting profession (in part because many pilots were ex-military), and yet somehow, that culture was changed to one of standard procedures, checklists, and Crew Resource Management. I'm still hopeful that the same can happen in medicine.

The relationship between the military and piloting actually may explain why standard procedures, checklists, and Crew Resource Management were more natural than in medicine, despite both being hierarchical and conservative.

I mean, the military is itself a hierarchical and conservative organization in which standard procedures, checklists, etc. are not exactly out-of-norm.

Fair statement but the military also has medical professionals. A wild speculative guess from my perspective is that airlines view it as an objective profession, you do these things to handle the machine and that is end of the story. Medical fields are somewhat subjective since we don't really understand the human body like we do airplanes - we didn't build humans from the ground up. We need to make the medical industry absolutely objective and quantitative in order for procedures and checklists to be effective. It still weirds me out how you need second "opinions" on a diagnosis, it just highlights our inability to understand ailments.

> Fair statement but the military also has medical professionals.

Sure, the military has medical professions, but the military is not as dominant a source of medical professionals as it has been for professional pilots. So, it seems (to me, at least) plausible that military culture might have a substantially stronger impact on the piloting profession than medicine.

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