Tuning in…
Tuning in…
Castaway
1 appearance
Surgeon and bestselling author who explores medicine as an imperfect science and created a preoperative checklist that halved surgical deaths.
On the island
Eight records
Love Struck Baby uh by Steve Rivaughn. I chose it um because it was my first date with my wife.
Sir Duke by Steve Ree Wonder. This was my first single that I bought.
This is Def Leppard's photograph. At the end of high school, I went with three other friends on spring break in Florida. … we had a tape deck, and I managed to bring only two albums. … they were on constant rotation for 23 straight hours.
I bring it on because when I got to college … it just completely switched me on to a whole range of music.
This song helps reflect the art of making an operating room playlist. … This is Tom Petty's American Girl. … it's on virtually every playlist that I put together for a day in the operating room.
Two Tribes. I chose it in part because it's a kind of funny story. … I had started dressing very cool and … we went to the concert.
Cleopatra by Weezer. I am obsessed by music. Rivers Cuomo contacted me … it was just such a thrill.
BodysnatchersFavourite
Bodysnatchers by Radiohead. I play this in the operating room. … I'm a devotee of Radiohead.
In conversation
Presenter asks
1:59If you were your doctor, what would you say to you about stress and getting more sleep?
Well, um, not a lot. In surgery, we tend to think that you haven't worked hard enough. We're always priding ourselves on how little sleep you've managed to get. But in a funny way, I've been always somebody who got my seven hours of sleep a night, and I constantly work at trying to get something done. And if I get something done, then I can feel happy with whatever I didn't get done.
Presenter asks
3:52Where is your thinking time? Do you build in thinking time for all the writing?
During surgery or during my clinic is not my thinking time. What comes out of those, though, are the things that keep you up at night or that you're puzzling over that you really wonder about, a mistake you made and why that happened and whether it was your fault and not your fault and how to think about that or patients who die. And that becomes my thinking time, is the time around the clinical time. And then the beauty of getting to be a writer is I can ask people to do things that would seem very odd. Like I can ask a patient, could I visit them at home and hear more about what was going on with this thing that didn't quite go right. Or I can interview other surgeons or people in public health to say, you know, tell me a time when it all went wrong for you. And I don't get permission normally to do that, but tell them I'm writing a book or writing for the New Yorker. And people suddenly say, sure.
The keepsakes
Presenter asks
Did you have an aha moment to come up with [the checklist]?
So first of all, the aha moment, there were many, and what it is, was basically bringing to the operating room the kind of pre-takeoff checklist your pilots use when you get on an airplane. So we were asking people to follow along a few basic steps that we did the research to identify what are the most common failures, and there were failures around unsafe anesthesia and blood loss and team communication. And the checklist was 19 items under two minutes before the anesthesia, before the incision, and before the patient left the room. Some simple things, you know, pretty dumb-sounding things like, do I have the right patient on the table? Do I know what their medical issues are and allergies are? Have I got the blood ready if we need the blood? But then the others are really about communication. Has everybody in the room introduced themselves by name? Has the surgeon briefed the team on how much blood loss to expect? Anything non-routine you should be aware of? Has the anesthesiologist briefed the team on the medical concerns about the patient? Has the nurse said what their plans are for the instruments? And it seems really mundane. One of the rules that I've discovered is there's no mistake too dumb for us to make. And deploying this two-minute checklist, including St. Mary's in London, in Toronto General Hospital, but also rural Tanzania in Delhi, eight cities, we had a nearly 50% reduction in death. So we published in 2009. I wrote my book about it in 2010. And most of the Western world has adopted this.
Presenter asks
8:43How do you think individual physicians should guard against being corrupted by their own power?
Well, I don't think that these are easily solvable problems by the individual physician. In other words, the amount of knowledge that you have to absorb to keep up, the range of skills that you're required to execute, are beyond the capacity of any individual. And therefore, what system you're part of and the extent to which you're also influencing a good system to get better and not in a system that is poor to begin with. That's a fundamental thing. You know, we discovered more than 4,000 different medical and surgical procedures during the last century. We've discovered more than 6,000 drugs, and we have an uncounted number of preventive solutions. And our job is to deploy that capability town by town to every person alive. Groups of people working together are far better than having the smartest, most experienced, most trained, and hardest working individual in the system. If they aren't part of a whole group of people who are all pulling in the same direction, communicating with the same consciousness of what a good outcome is, you don't get anywhere. It's why I worked on something that's seemingly mundane as a checklist. That checklist could take incredible experts, but also perfectly ordinary people, and have a 50% reduction in death across eight cities. That's bigger than any pill, any procedure, or the very smartest person.
Presenter asks
17:17How did you know how to run seventy five people in a policy unit?
Well, I mean, the the terrible story is that I didn't know how to run seventy five people. Um I didn't do a great job. You know, I would do I would micromanage in ways that don't work well. You know, I had multiple people resigning from my team because I would redo the work and it wasn't necessarily the best way to build a team.
Presenter asks
26:39What occurs to you about what matters in the end?
The key thing that I discovered, and I interviewed more than 200 patients and family members about their experiences with terminal illnesses or severe infirmities, was that we do not recognize that people have goals in their life, priorities, besides just living longer. The second thing that I discovered was that the most reliable way to find out what people's priorities are is to ask them, and we don't ask. Even for people within weeks of death, we don't ask. There's tremendous suffering when you have your clinicians and the system all assuming the most important thing to you is survival at all costs. And, you know, my father, as he was coming to the end of his, he had a brain tumor, his most important thing was social interaction. Can I talk to my friends and family? Can I be at the dinner table and actually still have this wonderful social existence that is the reason he wanted to be alive? And when the treatment started to sacrifice that, our recognizing that that was what was important led us to stop the things that took that away from him and let him be a person rather than a patient. And for me, being a person rather than a patient is: can I communicate with you? Can I still be in the world of ideas to some extent? And I'm able to have that kind of interaction. I'd be willing to go through a lot to keep that going.
“In surgery, we tend to think that you haven't worked hard enough. We're always priding ourselves on how little sleep you've managed to get.”
“I want my knots to be beautiful. Even though on some level it doesn't matter.”
“Groups of people working together are far better than having the smartest, most experienced, most trained, and hardest working individual in the system.”
“being a person rather than a patient is: can I communicate with you? Can I still be in the world of ideas to some extent?”