Why are doctors constantly told to adopt aviation safety practices? My own specialty of anaesthesia is particularly vulnerable, based on the dubious analogy that giving an anaesthetic is similar to flying an aircraft. Although initiatives such as the World Health Organization’s surgical safety checklist are generally welcome, the aviation model has only a limited place in medicine because there are fundamental differences between the ways in which doctors and pilots work.

Using a checklist should never detract from the priorities of flying an aircraft or looking after a patient safely. Immediate actions should be committed to memory, followed by reference to a concise aide memoire. Crucially, a checklist is distinct from a briefing, which is normally given at two specific times during a flight—before departure and before descent. A briefing deals with all the “what ifs?”(where to divert to in bad weather, what to do if an engine fails on take-off) and deliberately takes place at a time in flight when workload is relatively low. In the operating theatre the checklist and briefing have merged untidily— team introductions, discussions, and concerns are integral to a …