Anatomy of Error: A surgeon remembers his mistakes

Indeed - and an unawareness of fallibility or medical arrogance is a huge warning sign.

Many in the medical fraternity bury their mistakes, not admit to them.

Hope the "not" doesn't get smudged off.

Life imitates art: https://youtu.be/CmayBDhHD54?t=8s

I don't know how widespread this is, but when I went to get surgery on my foot (NHS in the UK) they literally drew an arrow on my leg with a marker pen to avoid operating on the wrong foot haha.

my dad was a nurse his whole career, worked in a variety of areas including surgery. After his returement he went in for surgery and wrote things like that on his body so they didnt fuck it up

Developers are less likely to be directly responsible for the sort of things that surgeons are, unless you write mission-critical software. However, if you write any kind of software that a lot (millions) of people depend on, there is a very good chance that you've ruined people's lives or even caused death.

I dread to think how many people's relationships have been destroyed because the developers of Facebook, Whatsapp, Telegram et al decided to implement read notifications/"last seen" on their instant messaging apps.

One of the interesting things about developing medical devices is the formal recognition of this process. During development, you must perform and document risk analysis - some of this is pretty dry, but part of it is a session of what-if where you need to look at the worst possible outcomes for you system, used properly or not. Often this is quite eye opening.

If there is an adverse event, or interaction reveals that one is possible, you'll do corrective-action/preventative-action analysis and depending on the severity you may need to inform you entire user base.

At first this sort of thing can feel process heavy and unwieldy, but I quickly came to appreciate the way in improved the actual engineering and made you think about system design in particular, useful ways.

In 2008 I left the structural engineering field. I have 0 deaths due to my actions. The decisions weigh on you, but not like medicine. Almost always your structure will survive and when it doesn't it will almost always give warning of its failure.

There's a fair bit of evidence that -- regardless of how they might seem at first -- these types of "checklist" procedures really do reduce error rates. Much of it is cross-pollination from aviation safety, where use of checklists has been standard procedure for a long time.

This New Yorker article talks a bit about the early days of aviation checklists, and some attempts to apply them in medicine, including a hospital which tried checklists as a method of avoiding common causes of line infections with IVs. The result:

These steps are no-brainers; they have been known and taught for years. So it seemed silly to make a checklist just for them. Still, Pronovost asked the nurses in his I.C.U. to observe the doctors for a month as they put lines into patients, and record how often they completed each step. In more than a third of patients, they skipped at least one.

The next month, he and his team persuaded the hospital administration to authorize nurses to stop doctors if they saw them skipping a step on the checklist; nurses were also to ask them each day whether any lines ought to be removed, so as not to leave them in longer than necessary. This was revolutionary. Nurses have always had their ways of nudging a doctor into doing the right thing, ranging from the gentle reminder (“Um, did you forget to put on your mask, doctor?”) to more forceful methods (I’ve had a nurse bodycheck me when she thought I hadn’t put enough drapes on a patient). But many nurses aren’t sure whether this is their place, or whether a given step is worth a confrontation. (Does it really matter whether a patient’s legs are draped for a line going into the chest?) The new rule made it clear: if doctors didn’t follow every step on the checklist, the nurses would have backup from the administration to intervene.

Pronovost and his colleagues monitored what happened for a year afterward. The results were so dramatic that they weren’t sure whether to believe them: the ten-day line-infection rate went from eleven per cent to zero. So they followed patients for fifteen more months. Only two line infections occurred during the entire period. They calculated that, in this one hospital, the checklist had prevented forty-three infections and eight deaths, and saved two million dollars in costs.

http://www.newyorker.com/magazine/2007/12/10/the-checklist?p...

The Checklist Manifesto is a great book on this topic: http://www.amazon.com/dp/0312430000

Thank you for posting this...surgery is one of the few professions that I think about, and then think, "Nope, no way, not even in the wildest dreams in an alternative universe, that I could ever be a surgeon"...but I get the sense that so much pride is tied up into the skill of a surgeon, such that mechanical ability and intuition are almost inextricable. I have no problem with the assertion that a human expert is needed to make decisions as the cuts are being made. But it's astonishing to me that so much of the success of surgery relies on a near-superhuman ability of muscle control and focus, an ability that surely declines with age, even as the surgeon's wisdom and experience grows. I would love to read more about "autopilot"-type advances in medicine (though too much of the coverage focuses on, "Will robots replace your doctor?" rather than man-and-machine working together)

Dick! - you obviously haven't had family who've gone through major life-threatening operations ... and come out alive.