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 quietly over
the patient's neck, exposed through a small hole in a sterile blue drape, where a thick necdlc
was entering under the collarbone. I noticed they had neglected to drape the abdomen and legs,
but at this point it didn't seem wise to interrupt the procedure, 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. After 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 developed a fever and her white blood cell count
shot 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. 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 infections by 66 percent 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 aid a staff writer at The
New Yorker, makes the case that checklists can help us manage the extreme complexity of the
modern world. In medicine, he writes, the problem is "making sure we npply the knowledge
we have consistently and correctly." Failure, he argues, results not so much from ignorance
(not knowing cnough about what works) as from ineptitude (not properly applying what we
know works). This is an important insight. Medicine has made grcat stides, but in many ways
doctors have become victims of their owa 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 meet national guidetines only slightly more than half the time.
      Medicine is not the only complex profession where lives are on the line. In making his
argument, Gawande dettly weaves in exariples of chocklist successes in diverse fields like
aviation and skyscraper construction. He maintains that checklists not only help pilots and
builders get the stupid stuff right, but foster the communication required to deal with the
unexpected. His discussion of aviation accidents, including the emergency landing on the
Hudson River last January (during which the copilot simultaneously managed checklists for
restarting the engine and ditching the plane), makes for fascinating rcading.
      But Gawande's missionary zeal can give the book a slanted tonc. For instance, there is
almost no discussion of the unintended consequences of checklists. Today, insurers arc
rewarding 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 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 being 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
recommendation in a checklist risks that these drugs will be prescribed to the wrong
patient-a 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 be useful for simple procedures like central line insertion, but they are hardly a
panacea for the myriad ills of modern medicine. Patients are too varied, their physiologies too
diverse and our knowledge still too limited.
      Gawande passingly notes that checklists could be uised to improve weather prediction.
But he doesn't mention that weather is an inherently chaotic phenordenon: small perturbations
in initial conditions can result in big, unpredictable eflects. Whea Gawande writes that an[!--empirenews.page--]
investment managcr 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 Checklist
Manifesto" is an essential primer on complexity in medicine. Doctors rosist checklists because
we want to believe our profession is as much an art as a science. When Gawande surveyed
members of the statl' at eight hospitals about a checklist developed by his research team that
nearly halved the number of surgicat deatis, 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 opcration, 93 percent said yes.
【題組】45. What type of writing does this article belong to?
(A)A sociat commentury
(B) A medical report
(C)Abook review
(D) A traveloguc