Views & Reviews Review of the Week

Boxing clever

BMJ 2010; 340 doi: (Published 27 January 2010) Cite this as: BMJ 2010;340:c514
  1. John Quin, consultant physician, Royal Sussex County Hospital, Brighton
  1. John.Quin{at}

    Don’t underestimate the power of box ticking, says John Quin

    Tick box exercise. When was the last time you heard that cliche spoken with barely concealed scorn? Yesterday? A spirited polemical defence is overdue, and Atul Gawande takes up this quixotic task with relish. Gawande is the only endocrine surgeon on earth writing for the New Yorker, so it is no surprise that he argues eloquently and persuasively for the humble checklist. His pitch is candid about the delusions we work under and insightful about our self justifications for cutting corners. He acknowledges that “we don’t like checklists—they can be painstaking. They’re not much fun.” Tell that to a jet pilot or passenger. It doesn’t mean we shouldn’t do them.

    He is precise about the problem: our “stupendous know-how” has outstripped our “individual ability to deliver its benefits correctly, safely, or reliably.” Medicine, with its 700 000 journal articles a year, has become “the art of managing extreme complexity.” A wise colleague (thank you, Huw Albyn Davis) once described the average post-take ward round as akin …

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