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Comment by clumsysmurf | Hacker News Reader

My friend worked in a pathology lab, run by a recognized world expert in the field (wrote college texts, gave lectures, etc) yet the performance was 'mediocre' due to reoccurring mistakes made by humans:

* Doctors disagreed with each other frequently. Most senior won.

* Results from one patient were given to another patient

* ... or results were lost entirely

* Lab destroyed samples before examination or stained incorrectly

* Samples never received, lost in mail or never picked up from airport

These folks did have a tough job, looking into microscopes for many hours per day. At some point I imagine things just start looking the same as fatigue sets in.

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May be the next medical breakthrough is really going to be TODO lists.

Which reminds me of Lotus Notes. 20 years ago it widely used to automate workflows. But I haven't seen anything similar widely used since.

It already is:

From: The effects of safety checklists in medicine: a systematic review: [1]

Safety checklists appear to be effective tools for improving patient safety in various clinical settings by strengthening compliance with guidelines, improving human factors, reducing the incidence of adverse events, and decreasing mortality and morbidity. None of the included studies reported negative effects on safety.

[1] http://www.ncbi.nlm.nih.gov/pubmed/24116973

To me, this is a generalization of the benefit of software/automation: what we're really discovering is that when we force people to think through all the edge-cases in a process in order to explain that process to something as dumb as a computer—or a checklist—we dig up a lot of implicit institutional knowledge that, crucially, not everyone has. (Everybody that had it just assumed everyone else knew!)

The result of such a process can be a checklist, or a workflow diagram, or a program. The form of it isn't really important, so much as the fact that the business logic being applied (by a human or a computer) to each case now embeds all the previously-scattered knowledge of the domain explicitly, making each node applying it behave as the union of its institution's knowledge-bases, rather than as the intersection of those knowledge-bases.

Also, a checklist doesn't get tired and forget a step.

You've heard of The Checklist Manifesto?

Medicine features in it.

Protocol books formalize checklists for ER medicine, over-the-phone triage, etc.

> Doctors disagreed with each other frequently. Most senior won.

I'm told this is a huge problem in medicine. They might be even more hierarchical than the military.

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