The Checklist Manifesto: How to Get Things Right

by Atul Gawande

I asked the people in Harvard Vanguard’s medical records department if they would query the electronic system for how many different kinds of patient problems the average doctor there sees annually. The answer that came back flabbergasted me. Over the course of a year of office practice—which, by definition, excludes the patients seen in the hospital—physicians each evaluated an average of 250 different primary diseases and conditions. Their patients had more than nine hundred other active medical problems that had to be taken into account. The doctors each prescribed some three hundred medications, ordered more than a hundred different types of laboratory tests, and performed an average of forty different kinds of office procedures—from vaccinations to setting fractures. Even considering just the office work, the statistics still didn’t catch all the diseases and conditions. One of the most common diagnoses, it turned out, was “Other.”

Maybe physicians need research assistants for non emergency cases that appear complex.