Hacker News Reader

> Airplane pilots use checklists. It's illegal to start the engines unless the approved checklist book is within reach of the pilot in command. In training it's drilled into us that the response to panic is: get out the checklist and follow it. It works.

Just some clarifications:

- It's not illegal to fly without a checklist under Part 91 (non air-carriers.) When I fly with military pilots, they use a flow for starting small airplanes:

http://fsims.faa.gov/PICDetail.aspx?docId=8900.1,Vol.3,Ch32,...

- the airplane manual is a book, and must be on the airplane. A checklist is a list, not a manual. The checklist can be electronic, as in the HondaJet.

- it's a good idea to follow the emergency procedures either from memory, or a checklist if there's time. Typically recovering from a stall or spin, or feathering a bad engine is done from memory, for example.

Source: commercially-rated airplane pilot.

Without any specific relevant experience in a hospital, isn't the most likely reason procedures fail that people are required to ignore/bypass parts of them constantly, rather than having them updated to match reality?

It seems so very obvious to me that any time you start asking, from a 40,000 foot level, why people can't follow simple instructions, the answer is going to be, not that they are all idiots, but that they are trained and required to ignore them selectively based on complex ever shifting criteria. That is basically what makes any job require a human and not a computer in the first place.

The more rigid you want people to be, the better the process has to be.

> But, even in the 21st century, it's a struggle to get compliance with hand-washing rules in hospitals.

I think it's more likely that there is an immediate feedback loop to disregarding the checklist (i.e. the plane crashes and the pilot dies), whereas not washing your hands has a lot more delayed consequences in which the causation isn't readily known. I think this is the general problem with Outcomes Based Health - we have the stats to back up its effectiveness, but don't have the immediate feedback loops to promote it.

> In training it's drilled into us that the response to panic is: get out the checklist and follow it

I do this, and always teach others to do this, during incident response. The reason I think it works is it reduces your burden for making decisions during a stressful time. No matter who you are, how good you are at managing stress, or how experienced you are, you’ll almost always end up making worse decisions under pressure, so removing the need to make decisions as much as possible seems to generally lead to better outcomes.

> But, even in the 21st century, it's a struggle to get compliance with hand-washing rules in hospitals.

Wash your hands 12 times a day for a week and you'll understand why people might not want to comply.

I want my doctor to wash his hands, but I can at least sympathize as to why he might not want to.

I have twin infants, a toddler, and work in a large office unrelated to medicine. I wash my hands on average 2 * 12 times a day, every day. It's my job to keep my family healthy. I suppose we are saying it is arguable that it's not the job of medical professionals to keep their patients healthy?

Hippocratic oath must be window dressing these days.

When you say you "wash" your hands, do you do a full "apply soap to all sides of hands" every time?

Personally, I rinse my hands (i.e. with only water) pretty frequently, but only wash with soap when the occasion calls for it (when arriving home, when my hands are greasy, or after sitting at the toilet), which probably averages 2-3 times per day.

On a separate note, my family doctor used some kind of antiseptic and moisturizing lotion on his hands. He said the antiseptic would tend to dry the skin, so adding a moisturizing element to it was a genius idea and whoever came up with it was probably making millions.

> I wash my hands on average 2 * 12 times a day, every day.

I simply don't believe you.

That would imply that you spend almost an hour per day washing your hands if you are following proper hand hygiene.

With twin infants and a toddler, I'm pretty sure you simply don't have that kind of time in a day.

> But, even in the 21st century, it's a struggle to get compliance with hand-washing rules in hospitals.

Ever talked with a nurse or a doctor? The reason is simple: way, way not enough staff at hand combined with maximum allowed/planned time for a certain procedure (e.g. 10 minutes for a full assisted shower) which only works in perfect conditions but falls apart under the slightest change (e.g. patient wet themselves), and combined with ruthless MBA-style C-level execs actually firing people for not keeping up with the numbers.

Medicine, especially highly critical / urgent care, needs to be socialized and shielded off from all negative effects of modern-day capitalism if this is to change.

You want to solve a problem caused by shortages with policies that historically always causes shortages? (Socialism)

Medicine is heavily regulated everywhere and people always complain about the same problems in the US and Europe, and these problems are the same kind of problems caused by regulation and guild-like organizations all around the world, in all industries at all points in time.

Even if you were to let someone else pay the bill, it's idiotic to have things organized as they're now.

There wasn't a nursing shortage back when the county ran the hospital in my area. But you know the laws of supply and demand: corporations have to manufacture scarcity to drive up KPIs

>Medicine, especially highly critical / urgent care, needs to be socialized and shielded off from all negative effects of modern-day capitalism if this is to change.

If anything it’s existing shielding is the problem. The supply of doctors is artificially controlled and limited which means you can’t lower pressure through capitalistic approaches. Without fixing the supply (more doctors) or demand (don’t treat patients) issue these problems won’t go away.

The nursing shortage could be solved by hiring more. They overwork the few they hire so the MBA execs can buy nice things

> The nursing shortage could be solved by hiring more.

At least in Germany, there are massive amounts of open job postings for nursing and other care staff. The problem is that the wages are way too low, as the county/city-owned clinics have to adhere to the budget rule of maximum efficiency and minimum taxpayer subsidies (which led to massive outsourcing and other cost saving efforts in Munich [1]) and private-owned clinics are under financial pressure from their owners (you gotta make those 18% EBIT [2] somehow), while at the same time the amount of money that the public health insurances pay for procedures (fixed rates across the country) is not enough to cover these costs.

[1] https://www.kma-online.de/aktuelles/klinik-news/detail/staed...

[2] https://www.boeckler.de/117585_118442.htm

I meant specifically in the US market where one aspirin pill is billed to the patient as a $30 expense. Not in a country with free healthcare.

Gloves are another one.. blows my mind.