Today we begin the read of the The Checklist Manifesto by Atul Gawande (use the link and buy a copy so you can read along). The version of the book we are reading is published by Metropolitan Book, 2009 and is the 22nd printing. The book has nine chapters and with acknowledgments has 209 pages. My reading plan is one chapter per week, therefore, the re-read will span 11 weeks (including today).  


Until relatively recently I did not read forewords and introductions. I think I have missed a lot of contexts. The Checklist Manifesto starts with two stories from the medical arena. In the first story, the doctor missed a piece of knowledge that nearly killed the patient. If the attending physician had asked about the type of weapon that caused the wound the patient would have had less of an issue. In the second story, the surgical team missed a slight (but important) treatment deviation that stopped the patient’s heart. The patient only survived because the team stumbled over the deviation in the norm.

Prior to writing The Checklist Manifesto the paper, Toward a Theory of Medical Fallibility (note the paper, although thought provoking is difficult to get. I found a source to read online but a copy is $18 USD) made a major impact on Gawande’s thought process. The paper lays out a framework to understand why mistakes are made. There are two overall categories of mistakes. The first is due to havingonly partial understanding. For example, trying to generate cold fusion and failing, falls into this category because no one knows how to generate cold fusion, we have a partial understanding. The second category is ineptitude. Ineptitude describes incidences that in which knowledge exists but is not applied correctly. Checklists, and therefore the book, are a tool to attack the second type of incident. The idea, that some mistakes or errors are controllable and some are not might not sound earth-shattering. Not adopting a way to deal with those that are controllable is disconcerting.  

The introduction was worth the price of admission! Why didn’t I read introductions and forewords in the past . . . silly me.