Medical patients are not aircraft

As we begin 2018, the aviation industry has something to be proud of: in 2017, there were no fatal aircraft accidents. They’ve worked for a long time, they’ve worked hard, they’ve worked smart, and there was probably some luck involved as well. There’s a lot of people who got a lot of things right every day of the year, and it’s a fantastic result.

Meanwhile, there are a lot of doctors on Twitter who are miserable when they compare their performance against the aviation sector. They (correctly) know that they are just as smart and capable as pilots and they (incorrectly) think that they can copy the aviation industry and achieve the same results. A rectal craniectomy may be indicated: medical patients are not aircraft.

Aircraft are extremely consistent machines. The task of a pilot is to operate that machine in a highly variable environment (the atmosphere) that follows rules that we mostly understand. Failure of the machine is mostly preventable; when it occurs, current technology provides definitive information about the nature and the extent of the failure. Repairs to the machine are performed when it is not running or being operated. Pilots are expected to refuse to take off if the plane is likely to crash.

Humans are highly variable machines. The task of a doctor is to repair that machine while it is running, and often while the operator is actively using it. Failure of the machine is a prerequisite condition for the doctor’s work to begin. When it occurs, current technology provides mostly-reliable information about the nature and extent of the failure. For most doctors, the environment they work in is predictable and reliable. Doctors are expected to focus their efforts on patients who are likely to die.

The miracle is that there are some lessons that do transfer from aviation to medicine: especially in surgery, where the unconscious patient makes it possible to have candid conversations while performing the work.

If you want to really understand this issue, then it helps to read the views of an Air Force trained pilot who is now working in emergency medicine.

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Nick Argall is an organization engineer, structuring activities to help businesses achieve their goals.

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