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Comment by y0ghur7_xxx | Hacker News Reader

> They fail because of severe checklist fatigue

> checklists often leaves a lot to be desired.

You say yourself that checklists are great, and it is proven that they save lives. So if there is fatigue in using them over and over, and they are not perfect, well... get over it? Sure i can understand that it's boring to go through the same checklist 5 times a day, but come on, there are lives at stake here. If one of your wife patients gets an infection and dies because she forgot some important, simple, step because of "checklist fatigue" how would she feel?

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I don't think that's what checklist fatigue means -- it's not about boredom or tedium.

It means that the more you keep having to skip over irrelevant items and the more you still depend on remembering other things that aren't on the checklist, the less likely any human being is to reliably follow the checklist -- because they accidentally skip over an item thinking it was the irrelevant one, or jump back to the wrong item (skipping others) because they got "off" the checklist to do steps that weren't on it.

The point of a checklist is that it's supposed to be a single idiot-proof source of truth in a specified area, reducing mental complexity and therefore reducing errors.

Once it stops being that because it isn't perfect, it can easily increase mental complexity which requires more brain use and increases errors. That's the fatigue.

So it's not a question of just "getting over it".

Keeping a checklist up to date is incredibly important.

If you have skip items on a list, then human error pops up again

The Messiah/God complex is a very real thing with MDs. It's dependant upon the enviroment and training, but a lot of them really do think that they are 'special' and that they have 'proved' themselves via the rigours of school and residency. Their sense of self is tied up into their job preformance. Like in other professions, if you 'attack' their job and their work, you are attacking them personally.

> The Messiah/God complex is a very real thing with MDs.

That's true with pilots, too, especially fighter pilots. But they rigorously use the checklists.

The pilots also know that many crashes have been traced to skipping an item on the checklist. For example, John Denver's fatal crash was due in part to failing to fuel the airplane before flight.

Fighter pilots aren’t going to get paid more if they cram in an extra mission by skipping steps.

Fighter pilots aren't in it for the pay. They often remark that they're amazed that people actually pay them to fly.

I'd forgive them for skipping the checklist if their airfield is under attack and they have to get their crates in the air or die on the field.

> aren't in it for the pay.

Nobody ever is. But if their contract negotiator ever opens with that line...

It's also probably partially attributable to the fact that it's their own life on the line if they skip a checklist step like lowering landing gear.

That in combination with training. It's just the cultural thing to do, everyone uses checklists, a pilot from the moment they start training is always doing check lists.

It also helps that a checklist for a plane is always relevant where a checklist for a procedure is more variable.

Their career is also on the line, even if they live through the incident. Nobody wants to keep on a pilot who is careless with at $100m machine.

Yeah there's definitely a difference in the culture where checklists are the norm in aerospace where they're a new and developing thing in medicine.

You're not going to cure the human condition. If checklist fatigue is a real problem, telling people to suck it up and do their jobs is not going to work. The process needs to be improved to account for check list fatigue, it's that simple. Be it read aloud each item before checking it off, have a secondary scribe confirming and checking it off, or any other improvement that minimizes the effect of the fatigue.

No matter how right you might be, "get over it" is not an effective way to change human behavior.

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