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 necdlcwas entering under the collarbone. I noticed they had neglected to drape the abdomen and logs,but at this point it didn't seem wise to interrupt the procedure, so I let it go. They had alsoapparently forgotten to don face shiclds 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 developed a fever and her white blood cell countshot up. The line had to come out. Bacterial cultures 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 infeetions 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 staft writer at TheNew Yorker, makes the case that checklists can help us manage the extreme complexity of themodern world. In medicine, he writes, the problem is ''making sure we apply the knowledgewe have consistently and correctly."' Failure, he argues, rosults not so much from ignorance(not knowing cnough about what works) as from ineptitude (not properly applying what weknow works). This is an important insight. Medicine has made great stides, but in many waysdoctors have become victims of their owa success Taking care of patients is hard； there isoften too much for one doctor to do. Medical care for common disorders like diabetes andpreumonia has been shown to meet pational guidetines only slightly more than half the time.        Medicine is not the only complex profession where lives are on the linc. In making hisargument, Gawande deftly weaves in exampies of chocklist successes in diverse fields likeaviation and skyscraper constructon. He maintains that checklists not only help pilots andbuildcrs get the stupid stuff right, but foster the communication required to deal with theunexpected. His discussion of aviation accidents, including the emergency landing on theHudson River last January (during which the copilot simultancously managed checklists forrcstarting the engine and ditching the plane), makes for fascinating reading.        But Gawande's missionary zeal can give the book a slanted tonc. For instance, there isalmost no discussion of the unintended consequences of checklists. Today, insurers arcrewarding doctors for using checklists to treat such conditions as heart failure and pneumonia.One item on the pneumonia checklist--that antibiotics be administered to patients within sixhours of arrival at the hospital--has been especially problcmatic. Doctors often cannotdiagnose pneumonia that quickly. But with money on the line, there is pressure on doctors totreat, even when the diagnosis isn't firm. So more and more antibiotics are being used inemergency rooms today, despite the dangers of antibiotic--resistant bacteria andantibiotic-associated infcctions.        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 disorderscoexist in the same patient, as is often the case with the elderly. And checklists lack flexibility.They might be useful for simple procedures like central line insertion, but they are hardly apanacea for the myriad ills of modern medicine. Patients are too varied, their physiologies toodiverse and our knowledge still too limited.        Gawande passingly notes that checklists could be used to improve weather prediction.But he doesn't mention that weather is an inherently chaotic phenonenon: small perturbationsin initial conditions can result in big, unpredictable eflects. When Gawande writes that aninvestment manager he knows believes a checklist can help him reliably beat the stock market,the case seems to have been pushed too far. Yet despite its evangelical tone, "The ChecklistManifesto" is an essential primer on cumplexity in medicine. Doctors rosist checklists becausewe want to believe our profession is as much an art as a science. When Gawande surveyedmembers of the statt' at eight hospitals about a checklist developed by his research team thatnearly halved the number of surgicat deatis, 20 percent said they thought it wasn't easy to useand did not improve safcty. 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 bclong to?[!--empirenews.page--]
(A) A social commentary
(B) A medical repor
(C) Abook review
(D) A travelogue