I have long been interested by the comparisons which are made between
medicine and aviation, such as the one made in this article, which
compares healthcare safety to carrier flight deck operatations. I believe
that if the authors, and others who have made similar comparisons,
understood aviation safety in greater detail, they would be less likely to
make such comparisons.
Pilots are usually only certified to fly one particular type of aircraft,
often only a sub-type of that plane, for example, the 400 series of a
Boeing 737, but not the 800 series. In addition, they usually work in
pairs, with a co-pilot backing up all cockpit decisions on the majority of
commercial flights. Navigation is under the control of twin flight
computers, loading flight plans which are programmed by external experts,
and the most dangerous phases of flight, approach and take-off, are done
under the control of Air Traffic Controllers. There are published
procedures for taking off and landing at airports, and on carriers, which
must be rigidly adhered to. Planes have to be serviced at regular
intervals, and at great expense.
Compare this to medicine. The domain of knowledge is virtually unlimited
compared to aviation, much risk is uncontrolled due to the impossibility
of writing procedures which cover all the variables involved, and patients
are free to smoke, drink, take drugs and overeat as part of the freedoms
of a democratic society. The general public would be shocked if planes
were treated the way they treat their own bodies, and would refuse to fly,
I suspect.
So while there are lessons to be learned from aviation, it is simplistic
to take aviation safety as a parallel, and given that the BMJ has banned
the use of the word "accident" from its pages, I would suggest that it
takes a similar line with comparisons with aviation safety. By all means
make them, but can authors please take greater care to understand what
they are comparing?
Rapid Response:
Comparing medicine and aviation safety
Dear Sir,
I have long been interested by the comparisons which are made between
medicine and aviation, such as the one made in this article, which
compares healthcare safety to carrier flight deck operatations. I believe
that if the authors, and others who have made similar comparisons,
understood aviation safety in greater detail, they would be less likely to
make such comparisons.
Pilots are usually only certified to fly one particular type of aircraft,
often only a sub-type of that plane, for example, the 400 series of a
Boeing 737, but not the 800 series. In addition, they usually work in
pairs, with a co-pilot backing up all cockpit decisions on the majority of
commercial flights. Navigation is under the control of twin flight
computers, loading flight plans which are programmed by external experts,
and the most dangerous phases of flight, approach and take-off, are done
under the control of Air Traffic Controllers. There are published
procedures for taking off and landing at airports, and on carriers, which
must be rigidly adhered to. Planes have to be serviced at regular
intervals, and at great expense.
Compare this to medicine. The domain of knowledge is virtually unlimited
compared to aviation, much risk is uncontrolled due to the impossibility
of writing procedures which cover all the variables involved, and patients
are free to smoke, drink, take drugs and overeat as part of the freedoms
of a democratic society. The general public would be shocked if planes
were treated the way they treat their own bodies, and would refuse to fly,
I suspect.
So while there are lessons to be learned from aviation, it is simplistic
to take aviation safety as a parallel, and given that the BMJ has banned
the use of the word "accident" from its pages, I would suggest that it
takes a similar line with comparisons with aviation safety. By all means
make them, but can authors please take greater care to understand what
they are comparing?
Andrew Herd
Competing interests: No competing interests