Applying Dr. Gawande’s Checklist in Dentistry
If you’ve ever sat down to a dental procedure only to be frustrated by not having relevant instruments or materials nearby, or if you’ve had an intra-op complication that could have been prevented if there had been a pre-op review with the team, then Dr. Atul Gawande’s “The Checklist Manifesto: How to Get Things Right” is the book to read.
Dr. Gawande is a phenomenal writer and surgeon based in Boston, Massachusetts, and world-renowned in the field of public health. Not only was his book eye-opening, it resonated with me as I entered my operatory ready to prep for crowns and composite fillings.
One area that uses checklists extensively is the aviation industry. Pilots are known for developing and continuously improving their pre-flight checklists and actually referring to them in crisis situations. And, when a failure or accident occurs, the industry moves swiftly and modifies flying practices and checklists. Dr. Gawande investigates why the checklist is so crucial to safe flying and to seamless communication between pilots, co-pilots and crew in times of disaster. His goal (and, primarily, that of the World Health Organization) was to reduce preventable surgical complications and to streamline team communication within the operating room. Ultimately, he developed his own checklist in his operating room and was successful in having surgical hospitals around the world adopt checklists as universal standards for surgery. He describes how, on several occasions, he had not met his surgical team prior to a surgery and explains how his pre-surgical checklist involves introductions, reviews of the case as a team in order to catch any missed details, and “pause points” to ensure all are on the same page.
As I read through the fascinating but terrifying realities and difficulties of modern medicine, aviation and skyscraper construction, I quickly drew parallels with dentistry. Dentistry has its own complexities. We have special considerations such as patients who are unable to recline, have sensitive gag reflexes or are medically compromised, not to mention the plethora of material or instrument options earmarked for specific procedures. And, unlike surgeons, we actually have to leave the room and our patients at least once during a procedure to complete a hygiene check/exam or to attend to an emergency. I wonder how many of us use checklists, run through our day with our team and plan for the expected as well as the unexpected? Or do we mostly just wing it and see how things go?
There is a reason why my morning team huddles exist and, if done correctly, work well. Thankfully, most of us have been working with our dental teams for years. But, while staff may stay consistent, dentistry and patients do not. Checklists can be customized and refined as needed in our field, and we should never feel we are too experienced to use them. As treatment standards evolve and patient difficulties increase, we should be more prudent than ever to not rely on chance but to cohesively prepare as much as possible for what lies ahead. After all, if our pilots and surgeons rely on checklists, why shouldn’t we?
Dr. Gawande is a phenomenal writer and surgeon based in Boston, Massachusetts, and world-renowned in the field of public health. Not only was his book eye-opening, it resonated with me as I entered my operatory ready to prep for crowns and composite fillings.
One area that uses checklists extensively is the aviation industry. Pilots are known for developing and continuously improving their pre-flight checklists and actually referring to them in crisis situations. And, when a failure or accident occurs, the industry moves swiftly and modifies flying practices and checklists. Dr. Gawande investigates why the checklist is so crucial to safe flying and to seamless communication between pilots, co-pilots and crew in times of disaster. His goal (and, primarily, that of the World Health Organization) was to reduce preventable surgical complications and to streamline team communication within the operating room. Ultimately, he developed his own checklist in his operating room and was successful in having surgical hospitals around the world adopt checklists as universal standards for surgery. He describes how, on several occasions, he had not met his surgical team prior to a surgery and explains how his pre-surgical checklist involves introductions, reviews of the case as a team in order to catch any missed details, and “pause points” to ensure all are on the same page.
As I read through the fascinating but terrifying realities and difficulties of modern medicine, aviation and skyscraper construction, I quickly drew parallels with dentistry. Dentistry has its own complexities. We have special considerations such as patients who are unable to recline, have sensitive gag reflexes or are medically compromised, not to mention the plethora of material or instrument options earmarked for specific procedures. And, unlike surgeons, we actually have to leave the room and our patients at least once during a procedure to complete a hygiene check/exam or to attend to an emergency. I wonder how many of us use checklists, run through our day with our team and plan for the expected as well as the unexpected? Or do we mostly just wing it and see how things go?
There is a reason why my morning team huddles exist and, if done correctly, work well. Thankfully, most of us have been working with our dental teams for years. But, while staff may stay consistent, dentistry and patients do not. Checklists can be customized and refined as needed in our field, and we should never feel we are too experienced to use them. As treatment standards evolve and patient difficulties increase, we should be more prudent than ever to not rely on chance but to cohesively prepare as much as possible for what lies ahead. After all, if our pilots and surgeons rely on checklists, why shouldn’t we?
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