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Summary: The Checklist Manifesto–Chapter 1 The Problem of Extreme Complexity

A Swiss rural hospital in Klagenfurt manages to save a girl who drowned in icy water via a complex series of coordinated actions involving the dispatchers, EMTs, nurses, and doctors. Medicine has been getting increasingly complicated with many different specialties, and specialties within specialties. In addition, doctors see patients having many different maladies, prescribing many different drugs, tests, and procedures. The computer systems which manage the patient history cannot even keep up. When attempting to specify the patient diagnosis, the most common response is “Other,” for there is no option for that particular diagnosis. There are lots of different actions that must be performed with each patient. Missing any one of these may cause the patient discomfort or something worse.

Gawande brings up the case of a patient with a failed liver whose condition was improving when his vitals became unstable. The lines connecting him to life- saving machines were all infected. The patient had been endangered not by his condition but by preventable environmental factors. Gawande ends by posing the question, “What do you do when expertise isn’t enough?”