Sunday, July 17, 2011

An iPhone App for Medical Checklists?


Not quite, but my iPhone inadvertently made a strong case for medical checklists.

This past weekend, I was once again in Denver. Colorado is a great destination for those who love natural beauty and outdoor adventure. My own personal adventure involved a fierce competition between me and water. Which machismo activity was I engaged in?

  • Level 5 white water rafting
  • Slalom water skiing
  • Cliff diving
  • Hang gliding with water landing
  • Sitting poolside with my iPad
If you are agonizing over the above choices, then you don’t know me.

I put the iPad down and crept into the pool slowly. Why do folks in the pool always beckon others in claiming the water temperature approaches hot tub levels, when it’s freezing? I’ve never been one to dive right in. I enter at a glacial pace. I dipped my toe in and in 10 short minutes, the water and I became as one. Then, the shock struck me with cold fury. Had Zeus pierced me with a lightning bolt, it would have been a mere pinprick in comparison. At that moment, I am standing in the pool with the water level at my navel. The iPad was resting safely on a nearby lounge chair. The iPhone, however, was in my pocket, an electronic submersible being bathed in chlorine.

While it took me 10 minutes to enter the pool, it took me 10 nanoseconds to exit it. The iPhone was dead. There were no breath sounds or pulse. I scanned the area for an AED (automated external defibrillator), not for the fibrillating phone, but for its terrified owner. ‘Get some rice’, my friend exhorted. I had heard of this fantasy where dead phones were resuscitated by lifesaving, hydrophilic rice. I sprinted to the hotel restaurant and received a large container of raw rice. I plunged the iPhone into the abyss and prayed for a miracle.

How could I be so careless? Humans make mistakes and I am a typical Homo sapiens. Who hasn’t locked their car keys inside their car, placed a food item in the fridge that needed to be frozen or left the umbrella in the car at the wrong time? Yes, to err is human, but drowning your iPhone seems downright inhuman. Indeed, if there were an eighth deadly sin…

Could this catastrophe have been avoided? What if I always performed a ritual prior to entering a pool, a lake or an ocean? What if I checked my bathing suit pockets every time before my toe hit the water? Had I done so, I would have discovered the iPhone before it became iDead. In other words, if I had a swimming checklist, my phone would still be alive today. If only I had considered this ‘app’ beforehand.

Medical checklists are red hot these days. These are procedures that doctors and nurses are encouraged or required to follow without exception to prevent human errors. The medical community has belatedly adopted this concept from the airline industry, where pilots proceed through an ordered checklist every time before take-off. Deviating from the ritual invites disaster, even though checklist adherence can become a mechanical process that can lose its meaning. (How closely do we listen to the flight attendants as they yawn through their safety presentations at the beginning of flights?) Checklists are being adopted in operating rooms throughout the country to reduce errors such as wrong sight surgeries and other preventable events.

Just this week, I read of two medical horrors that could have been prevented had checklists been followed.

  • The prestigious UPMC in Pittsburgh has shut down their living kidney donor transplant program when several folks missed that a donor was positive for hepatitis C. Yes, this tainted kidney was transplanted into an unsuspecting recipient. Whoops!
  • A Florida veteran is suing for a mere $30 million claiming he contracted hepatitis C from a colonoscopy performed at a VA hospital 2 years ago. It is well known that many cases of hepatitis C and other infections transmitted endoscopically occurred when standard scope cleaning procedures were breached.
My iPhone has been replaced costing me the $169 deductible on my replacement insurance and $16 for the screen protector, which probably costs Apple 3 or 4 cents each.


Santa


My advice? When you’re ready to dive in from the deep end, or you are poised to begin a colonoscopy, think of the sage advice from the Christmas standard, Santa Claus is Coming to Town. Are you making a (check)list and checking it twice?

14 comments:

Elaine Schattner, MD said...

Hi Michael,
Seems like there should be a checklist for wiping down i-devices. But with what antiseptic? And how often?

A. Bailey said...

You IMurderer!

Anonymous said...

Hello Michael!
I have been briefly through your blog, that I find very interesting, but i still have a -stupid- question for you :Were you ever retaliated against for your activities as a " Whistleblower"?
My e-mail : lat-123@hotmail.com
thank you

SisterBrendy said...

Oh thank you....I feel much better now, knowing that I'm not the only person today who drowned their phone. My phone was in my pocket since I was waiting for hubby to call to pick him up from hospital. Not wanting to waste my day sitting inside, I decided to skim my granddaughters pool. I found out that is the bottom of the pool is brown, look out, it is made up up something slimy and slippery. Two steps into the pool and down I went and I mean down, as in completely submerged! Even though I hurried to take the battery out and dry it, alas, it didn't help. If I didn't get such a kick out of watching my two year old granddaughter laugh her butt off, I would have surely cursed...okay, I did anyway, but she couldn't hear me since she was having such a fit of giggles. Thanks for making me feel better by sharing your story!

Michael Kirsch, M.D. said...

ES, I'm sure a waterproof iPhone is right now in R & D. With regard to AB's accusation, I am
iNNOCENT! To anonymous, I was reluctant to email you as I feared you might be the retaliation you asked about. SB, welcome to the club!

Nicholas Fogelson, MD said...

Not that you want to hear this now, but you can almost always get a wet bit of electronics working again by taking it apart and letting it really dry out. The problem is that there is still water on the inside creating a short circuit, and that the inside is too closed to allow much evaporation.

I've saved many a pager from toilet damage in my time.

Michael Kirsch, M.D. said...

Nick, I certainly didn't have the techno skill to disassemble an iPhone, and I'm not sure it's possible. I did want to disassemble myself at that moment. Look for the emergence of waterproof smart phones, to be marketed to dumb folks like me who dive in the pool at the wrong time.

Nicholas Fogelson, MD said...

It is most certainly possible. You just need the right tools. http://www.ifixit.com has tutorials on taking apart most anything. One can even replace a broken glass relatively economically.

Nicholas Fogelson, MD said...

I doubt we will see waterproof phones from the factory. There is littel financial incentive to produce such a thing The lack of such a feature does not discourage purchase, yet its presence eliminates a number of customers that would have bought a new phones after dunking their old one.

They do make waterproof cases however. The most elegant and compact solution is the LifeProof case (http://www.lifeproof.com/). OtterBox has been around quite awhile but their product is a bit bulky.

Nicholas Fogelson, MD said...

You can probably still get your old phone working. Even if you have replaced it already if you can get it running again its worth about $200 on eBay.

Michael Kirsch, M.D. said...

There's a reason, Nick, the 'fix-it' web site sports the motto: "a how-to book for crazy people".

Michael Kirsch, M.D. said...

@nick, GYN by day, and techno-geek by night.

LeisureGuy said...

What fascinated me about checklists was the degree to which doctors fought against them and refused to use them. Apparently that is changing in some places, but by and large doctors failed to embrace this simple idea. Arrogance, I imagine, plus ignorance (not of medicine, but of human factors---and the arrogance is in thinking their expertise in a medical specialty translated to expertise in everything). I'm not referring to you, but to the what I observed among doctors (as documented in the New Yorker article about medical checklists not long ago).

And speaking of medical malpractice, the LA Times this morning has a headline story: "California medical board fails to discipline 710 troubled doctors". This is clearly a major contribution to medical malpractice and it doesn't seem to be able to be blamed on lawyers.

Michael Kirsch, M.D. said...

@LG, good to hear back from you. The link from the LA Times was enlightening. Keep us posted. I support checklists, but physicians are frustrated by the increasing burden of monitoring, 'accountability' and the Mother of All Aburdsity - Pay-for-Performance. Most of what these guys are measuring, doesn't really count.

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