Charlie Rose

Ramjet  04/28/2010 02:38 PM Report

I can endorse Atul’s perspective from both an aviation viewpoint and a neurology/oncology viewpoint since I have a deep experienced with both fields.

I’ve been a pilot since 1982 and a CNS brain tumor, type B lymphoma cancer survivor for over three years. I’ve witness the dark side of flying without a checklist having a few friends harmed and the need for neuro-surgery teams and medical staff to have a checklist for there practices. I’ve studied the history of aviation, with a focus of pilot training during WW2. Aviation and cancer therapies demand a check list do to the many steps evolved in each effort. Each effort has so many critical parts that to miss one and cause undue problem. Each displine leads to a crash of the aircraft to the crash of a patient despite the belief that we can do a repeated task without issue. The reality is in the world of aviation is we run through a checklist on take off and inbound before we land. We also finish the fight with a landing check list. It historically has worked without consequences.

The same effort should apply to the world of chemotherapies and radiation. I drew a parallel early in my journey with a brain tumor and chemotherapy from my passion of WW2 aviation. It’s like flying a B-17 Flying Fortress during WW2. The mission and target is Cancer. In chemo I have a ground crew (my hospital RN’s), my flight crew of pilot in command (me), my Co-pilot (my Doctor), bombardier (specialists), navigator (radiologists), communications (mission associates) that make my cancer mission a success.

I hope to meet Atul one day. We can explore the cancer missions and prove the “checklist” has tremendous advantages, not just in the world of oncology, but medicine itself.

REMant  01/12/2010 01:13 PM Report

This is a question of social insurance vs free mkt primarily, as well as a question of how to best deal with monopoly. In that respect it may be an indication of what may happen with financial regulation. The problem is how to have adequate care without excessive cost. My own feeling is that a lot of the deregulation that has occurred in the past several decades has resulted in lower costs, but also, less benefit. Take the airline industry, for example. I think that's because the industries were deregulated without financial credit being brought under control. If you want the mkt to work, you must have sound money. Then the mkt will take care of the moral hazards, the externalities, and provide the maximum benefit at the lowest cost, but not otherwise. Nice story about the B-17, but air superiority is a matter of fighters not bombers. My guess is that as B-17 pilots became more adept they didn't really need the checklist, unless they changed to another plane. Nevertheless pilots still run through them on every airline take-off. So does the mechanic who works on your car. And I use checklists, recipes, and the like, because I don't do the same things all the time, and would rather use my brainpower thinking about other stuff. Checklists also solve the problem of too many chefs, lack of communication or ill-defined responsibilities.