Surgery and the Airline Industry

I’ve written about this before, but the topic doesn’t go away and I’m growing weary of it. Hospital regulatory agencies in our state, and in most states, are being instructed the way in which the airline industry has become safe was through the use of certain regulations and imposed rituals. Especially being pushed on the medical community are the use of checklists, similar to what is used before and after a flight to assure that all procedures are carried out correctly. Our state is now instituting a checklist standard with 100% compliance by hospitals in our state and celebrated by meeting at the old Boeing plant in Seattle, Washington with an author of a favorite book detailing the use of airline safety procedures in health care industry.
I’m all for airline standards, but not in the “pick and choose” standard that is being shoved down our throats. There are too many other airline industry differences that are simply ignored, at the patient’s peril. I’ve discussed many of them in the previous post. Let’s re-hash a few of them.
1. Airline personnel work hours. The airline industry, as well as the government, has strict standards on the amount of fly that a pilot can do, or work that a repairman can do before exhaustion leads to inefficiency as well as mistakes. Nobody would ever dream of climbing on an airplane, where the pilot has been up the last 24 hours and is now exhausted. I have personally called for reform in this area with deaf ears listening. It is hard to imagine that a truck driver in our state is forbidden from driving his truck for greater than 8 hours straight, and yet physicians frequently work for 48-96 hours straight with nary a comment from the state about the dangers that this is imposing. I’ve asked both the medical society as well as state legislators to consider this problem, and it is swept under the rug. Yet, if there are any actions that could be taken to eliminate errors in medicine, this is certainly the most important. Even airline pilots, on long flights, have replacement pilots in the plane to prevent the pilot from having to fly for over 8 hours.
There are 2 main stresses on an airline flight, that of taking off, and that of landing. True, decisions may need to be made in the air, but the main stresses are the start and end of the flight. In medicine, the initial patient consult, the care during a moment of extreme instability, or the trip to the operating room may be likened to the takeoff and landing stresses. The period that physicians spend on call sitting by their beepers could be likened to the time in the air. It is similar, since the physician is still being called, and must make consequential decisions. Many of those decisions are made when awakened from sleep, and more often than not, a night on call will rarely give more than an hour of straight sleep in a night. Yet, we not only have to make significant decisions during the night but must show up at work and consult on new patients or operate the next day. Would anybody feel comfortable flying on an airplane where the pilot had no sleep in the last 24 hours? Thankfully, most patients have no clue how much sleep their surgeon had in the last 24 hours! Comparable to the airline industry, it would be like saying that the only legitimate work-time for the pilot was the time on takeoff and landing, and then who cares how much time is spent in the air since flight time is a low stress.
2. Co-pilots. It used to be that almost all surgical cases had two doctors in the room. For smaller cases, it was the surgeon and a family doctor, and for larger cases, it was two surgeons. Nowadays, it is almost impossible to get two surgeons both in the room at the same time. It is economically unfeasible, and we’ve been forced to adapt. This has mostly been to the greater risk of the patient. Two surgeons on a case always go quicker and better than one surgeon alone. It could be compared to the airline industry deciding that a co-pilot is too expensive to maintain and thus eliminating that position. Maybe it’s time to return to the co-pilot in surgery practice?
3. Retirement – My pilot friends tell me that the airline industry bumped up the age of mandatory retirement from age 60 to age 65. Frightening! Pilots need to go through more rigorous psychomotor testing to assure that they have good reflex timing as they age. Why aren’t they doing this for doctors, especially those who do procedures on people? We are required to take ever-expanding CME classes and tests to prove our mental competence, though it is dubious that either accomplish their intended task. At the same time, we are required to take courses in things we never intend to see or would not manage even if we encountered such a situation, since courses of themselves are absolutely no replacement for real-life experiences. I recently took a mandated pediatric trauma online course in order to maintain my ability to serve our hospital. I felt like I was in the military–dotting all my “i”s and crossing all my “t”s, yet realizing that I had not acquired any true competence at pediatric trauma. We don’t have simulators that can exactly match what a flight simulator can do for a pilot. There are no surgery simulators that will spray blood in your face and give you AIDS if you screw up.
At this time, I have no recommendations for the medical profession, but pray that it soon die the same death that all its patients will eventually experience. Physicians are unwilling to defend their profession from external abuse but complain bitterly about the loss of their profession. Medicine – R.I.P.