As a pilot and primary-care physician, I am familiar with both aviation and medicine (“Can Hospitals Learn About Safety From Airlines?” Review, Sept. 4). Aviation lives mainly in the world of physics and as such is more amenable to checklists. Complicated systems are linear; the amount of output (say, a throttle setting) corresponds to a predictable and reproducible change (in this case, thrust from an engine).

In medicine, the outputs are nonlinear and unpredictable. Eighty percent of medical diagnoses are from a history...

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As a pilot and primary-care physician, I am familiar with both aviation and medicine (“Can Hospitals Learn About Safety From Airlines?” Review, Sept. 4). Aviation lives mainly in the world of physics and as such is more amenable to checklists. Complicated systems are linear; the amount of output (say, a throttle setting) corresponds to a predictable and reproducible change (in this case, thrust from an engine).

In medicine, the outputs are nonlinear and unpredictable. Eighty percent of medical diagnoses are from a history alone—talking and listening to the patient. One cannot do a very good job of that in the typical eight minutes that a primary-care provider has with a patient now in the U.S. (at least I can’t). The industrialization of healthcare with standards of care and checklists can deliver safety benefits. But I would caution that it could be at the risk of discounting and dehumanizing some of the “art” of medicine: the listening, caring and, yes, the laughter.

Mark H. Gregory, M.D.

St. Louis

Pilots, controllers and mechanics are able to communicate clearly about operations and incipient hazards because they use standardized terminology. Physicians, nurses and healthcare administrators are hampered by very poor adoption of standards for documentation. We struggle to communicate, but we continue to build and buy technology that uses proprietary operating systems.

Instead of adding yet another board, we should provide enforcement power to the federal government’s Office of the National Coordinator for Health Information Technology. The ONC has worked closely with healthcare providers to develop strategies to improve the interoperability of technology and standardize the documentation of patient care.

Let’s heal this self-inflicted wound.

Amy Garcia, R.N.

Overland Park, Kan.

Unlike the airline pilot, the surgeon in most cases doesn’t have a co-pilot. Years ago there existed an entity called the “assistant surgeon.” That individual was a fully trained, experienced second set of eyes, hands and surgical knowledge. That surgeon had a vested interest (medical, personal and financial) in the conduct of the case.

The surgeon’s assistant today is more likely to be an operating-room nurse, a registered nurse first assistant or a surgeon in training. Healthcare financial planners realized long ago that by eliminating the fee for the classic assistant surgeon, surgical costs would drop.

While I have respect and admiration for the contributions of nurses, nurse first assistants and surgeons in training, I cannot help but think that many surgical mishaps could be avoided if the assistant surgeon emulated the role of the airline co-pilot—experienced, involved and familiar with a variety of circumstances

Leo A. Gordon, M.D.

Los Angeles