Not long ago, I walked in on a group of medical residents inserting a central line catheterinto a patient in the intensive care unit. They were gowned and gloved, working quietly overthe patient's neck, exposed through a small hole in a sterile blue drape, where a thick needlewas cntering 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 alsoapparently forgotten to don face shields and caps. I let that go, too. Like them, I wanted to getthe procedure over with as quickly as possible before something bad happened. After thesenior resident pasted a clear sterile dressing over the insertion site, I congratulated him on ajob well done. But two days later, the patient devcloped a fever and her white blood cell countshot 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. AsAtul Gawande argues in "The Checklist Manifesto," these are situations where a simple to-dolist could help. For example, a five-point checklist implemented in 2001 virtually eradicatedcentral line infections in the intensive care unit at Johns Hopkins Hospital, preventing anestimated 43 infections and cight deaths over 27 months. Gawande notes that when it waslater tested in I.C.U.'s in Michigan, the checklist decreased infections by 66 percent withinthree 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 stail writer at TheNew Yorker, makes the case that checklists can help us manage the txtrome complexity of themodern world. In medicine, he writes, the problem is "'making sure we apply the knowledgewe have consistently and correctly." Failure, he argucs, rcsults not so much from ignorance(not knowing enough about what works) as from ineptitude (not properly applying what weknow works). This is an important insight. Medicine has made great siridcs, but in many waysdoctors have become victims of iheir ovn success: Taking care of patients is hard； there isoften too much for one doctor to do. Medical care for common disorders like diabctes andpneumonia has been shown to mniect pational guiddines only slightly more than half the time.        Medicine is not the only complex profession wiere lives are on the linc. In making hisargument, Gawande deftly weaves in cxarpies of checklist successes in diverse fields likeaviation and skyscraper construction. He mainitains that checklists not only help pilots andbuilders get the stupid stutl right, but foster the communication required to deal with theunexpected. His discussion of aviation accidents, including the emcrgency landing on theHudson River last January (during which the copilot simultaneously managed checklists forrestarting the enginc and ditching the plane), makes for fascinating reading.        But Gawande's missionary zeal can give the book a slanted tone. For instance, there isalmost to discussion of the unintended consequences of checklists. Today, insurers arerewarding doctoss for using checklists to treat such conditions as hcart failure and preumonia.One item on the pneumonia checklist-ㅡthat antibiotics be administered to patients within sixhours of arrival at the hospital--has been especially problematic. Doctors ofien cannotdiagnose pneumonia that quickly. But with money on the linc, there is pressure on doctors totreat, even when the diagnosis isn't firm. So more and more antibiotics are being used inemcrgcncy rooms today, despite the dangers of antibiotic--resistant bacteria andantibiotic-associated infections.        Even when doctors know what works, we don't always know when to apply it. We knowthat heart failure should be treated with ACE inhibitor drugs, but codifying thisrecommendation in a checklist risks that these drugs will be prescribed to the wrongpatient-a frail older patient with low blood pressure, for example. Checklists may work formanaging individual disorders, but it isn't at all clear what to do when several disordcrscoexist 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 apanacea for the myriad ills of modern medicine. Paticnts are too varied, their physiologies toodiverse and our knowledge still too limited.        Gawande passingly notes that checklists could be used te improve weather prediction.But he doesn't mention that weather is an inherently chaotic phenomenon small peiturbationsin initial conditions can result in big, unpredictable effects. Whep Gawande writes that aninvestment manager he knows believes a checklist can help him reliabty beat the stock market,the case seems to have been pushed too far. Yet despite its evangclical tone, "The ChecklistMani festo" is an essential primnet on cemplexity in medicine. Doctors resist checklists becausewe want to believe our profession is as much an urt as a science. When Gawande surveyedmembers of the staff at eight hospilals about a checklist developed by his research team thatncarly halved the number of surgical deaths, 20 percent said they thought it wasn't easy to useand did not improve safety. But when asked whether they would want the checklist used ifthey were having an opcration, 93 percent said yes.
【題組】45. What type of writing does this article belong to?[!--empirenews.page--]
(A) A social commentary
(B) Amedical teport
(C) A book review
(D) A traveloguc