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Rapid response to:

Head To Head Head to Head

Is WHO’s surgical safety checklist being hyped?

BMJ 2019; 366 doi: (Published 05 August 2019) Cite this as: BMJ 2019;366:l4700

Rapid Response:

Re: Is WHO’s surgical safety checklist being hyped?

Dear Editor

When I read the article on surgical checklists, the first question that springs to mind is this: does anyone seriously suggest, on the available data, that checklists are working to increase mortality and complication rates (i.e. that they are doing harm)?

The same question arose when I saw criticism of our compulsory cycle helmet laws, and of our aggressive advertising campaigns against smoking/tobacco.

There is no doubt that checklists could be improved, and that a "one size fits all" approach will work poorly in some contexts. It's also true (in that context) that an ill-conceived application (ill-conceived in a given context) could easily see the whole approach treated with derision, which is not what we want to see.

It's simply unreasonable to suggest that we can answer such a sweeping question (Are checklists useful?) in a manner that deals with all operations, in all clinical scenarios, for all conditions, and performed by a variety of different surgical teams. If there is one major criticism of the EBM movement, it would be that it reinforces the dichotomous thinking that everything will either be proven, or proven wrong, which grows from the way that so much of the medical/scientific literature is published.

Far more intelligent and useful to examine various circumstances separately, and to ask what is working and what is not working in each one, and then to go on to tailor a more and more effective intervention for each circumstance.

A final comment, and one that we should have heard before in discussing the role of cancer MDTs (the "evidence base" isn't strong, although I declare that I didn't re-review the whole literature before making that comment) is that the teams and hospitals most likely to implement these interventions early and then to do research on them and their implementation are (intuitively) the teams and hospitals less likely to need that intervention. Their results may not generalise to the whole world!

Kind Regards


Competing interests: No competing interests

22 September 2019
Sean DP Mackay
HPB, Upper GI, and Bariatric surgeon, Senior Lecturer
Eastern Health Clinical School, Monash University, Melbourne, Australia
5 Arnold St, Box Hill, 3128, Melbourne, Victoria, Australia