Not long ago, I walked in on a group of medical residents inserting a central line catheter
into a patient in the intensive care unit. They were gowned and gloved, working quictly over
the patient's neck, exposed through a small hole in a sterile bluc drape, where a thick needle
was entering under the collarbone. I noticed they had neglected to drape the abdomen and legs,
but at this point it didn't scem wise to interrupt the procedurc, so I let it go. They had also
apparently forgotten to don face shields and caps. I let that go, too. Like them, I wanted to get
the procedure over with as quickly as possible before something bad happened. Afier the
senior resident pasted a clear sterile dressing over the insertion site, I congratulated him on a
job well done. But two days later, the patient devcloped a fever and her white blood cell count
shot up. The line had to come out. Bacterial culturcs revealed it was infected.
      Doctors often overlook or omit steps in the multitude of tasks we perform every day. As
Atul Gawande argues in "The Checklist Manifesto," these are situations where a simple to-do
list could help. For example, a five-point checklist implemented in 2001 virtually eradicated
central line infections in the intensive care unit at Johns Hopkins Hospital, preventing an
estimated 43 infections and eight deaths over 27 months. Gawande notes that when it was
later tested in I.C.U.'s in Michigan, the checklist decreased infectiots by 66 pcrcent within
three months and probably saved more than 1,500 lives within a year and a half.
      Gawande, a professor of surgery at Harvard Medical School and a stait writer at The
New Yorker, makes the case that checklists can help us mianage the extreme complexity of the
modern world. In medicine, he writcs, the problem is making sure we apply the kaowledge
we have consistently and correctly:" Failure, he argues, results not so much from ignorance
(not knowing enough about what works) as from ineptitude (not properly applying what we
know works). This is an important insight. Medicine has made great stzidcs, but in many ways
doctors have become victims of ibeir own success: Taking care of patients is hard； there is
often too much for one doctor to do. Medical care for common disorders like diabetes and
pneumonia has been shown to niect national guiddlines only slightly more than half the time.
      Medicine is not the only complex profession where lives are on the linc. In making his
argument, Gawande deftly weaves in examples of checklist successes in diverse ficlds like
aviation and skyscraper construction. He maiitains that checklists not only help pilots and
builders get the stupid stu#! right, but foster the communication required to deal with the
unexpected. His discussion of aviation accidents, including the emnergency landing on the
Hudson River last January (during which the copilot simultaneously managed checklists for
restarting the enginc and ditching the plane), makes for fascinating reading.
      Bur Gawande's missionary zeal can give the book a slanted tone. For instance, there is

almost to discussion of the unintended consequences of checklists. Today, insurers are

rewarding doctoss for using checklists to treat such conditions as hoart failure and pnoumonia.

One item on the pneumonia checklist---that antibiotics be administered to patients within six

hours of arrival at the hospital--has been especially problematic. Doctors often cannot

diagnose pneumonia that quickly. But with money on the line, there is pressure on doctors to

treat, even when the diagnosis isn't firm. So more and more antibiotics are bcing used in

emergency rooms today, despite the dangers of antibiotic-resistant bacteria and

antibiotic-associated infections.

      Even when doctors know what works, we don't always know when to apply it. We know

that heart failure should be treated with ACE inhibitor drugs, but codifying this

mmendation in a checklist risks that these drugs will be prescribed to

patientㅡa frail older patient with low blood pressure, for example. Checklists may work for

managing individual disorders, but it isn't at all clear what to do when several disorders

coexist in the same patient, as is often the case with the elderly. And checklists lack flexibility.

They might bo uscful for simple procedures like central line insertion, but they are hardly a

panacea for the myriad ills of modern medicine. Paticnts are too varied, their physiologies too

diverse and our knowledge still too limited.

      Gawande passingly notes that checklists could be ised to improve weather prediction.

But he doesn't mention that weather is an inherently chaotic phenomenon: small perurbations

in initial conditions can result in big, unpredictable effects. When Gawande writes that an[!--empirenews.page--]

investmcnt manager he knows believes a checklist can help him reliabty beat the stock market,

the case seems to have been pusbed too far. Yet despite its evangelical tone, "The Checklist

Manifesto" is an essential primer on complexity in medicine. Doctors resist checklists because

we want to believe our profession is as much as unt as a science. When Gawande surveyed

members of the staff at eight hospilals about a checklist developed by his research team that

nearly halved the number of surgicat deaths, 20 percent said they thought it wasn't easy to use

and did not improve safety But when asked whether they would want the checklist used if

they were having an operation, 93 percent said yes.

【題組】45. What typc of writing does this article belong to?
(A) A social commentary
(B) Amedical report
(C) A book review
(D) A travelogue