Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Health care and the airline industry have a lot in common

Abraham Morse, MD, MBA
Policy
January 10, 2018
165 Shares
Share
Tweet
Share

There are many apt comparisons to be made between aviation and health care. As a (lapsed) instrument-rated pilot, I may have some insight about the system in which planes function on a daily basis in the United States. It is truly an impressive system which is (to paraphrase Don Berwick) well-designed to achieve the safety results that it does. However, the kind of statement that some health care safety leaders make in which they compare the raw mortality rates of acute hospital care and airline fatal accident rates is not so apt.

Let me see if I can explain why.

First, just to be clear, I have no illusions that we have a long way to go in optimizing the safety of medical care. I am a vocal advocate for transparent safety culture and adequate resource allocation for patient, staff and family safety. But we don’t do anyone any favors by sensationalizing and mischaracterizing where the problems are.

First, remember that in these aviation/medicine metaphors, airplanes are patients and “flying” is providing medical care. The thing is that the commercial aircraft that fly every day are required to regularly demonstrate that the performance of their critical systems meets or exceeds strict standards. If a radio, compressor blade, hydraulic line or pressurization fan is not operating within a very narrow performance range, the plane does not fly. With our fellow humans, we do not have this luxury. We don’t have too many replacement parts — and they have their own problems. When we admit a 72-year-old with heart failure, COPD and CRD we must do our best to keep them “flying” despite multiple marginally functioning critical systems.

Imagine flying a plane in which engine power is only 50 percent of normal and control services do not respond to input from the pilot reliably and where the radio is not always capable of receiving ground communications that are understandable to the pilots and crew. Also, the fuel tank is leaking. But you have to fly it no matter how many systems are semi or non-functional. At this point, you can’t simply follow the “standard procedures,” all of these accumulated problems make this plane a unique, untested system.

At some point, in the process of trying to improvise to keep this plane in the air, you may do something that results in an accident. However, it was really, “an accident waiting to happen.” It’s almost unavoidable for the brave souls who were trying their best to keep the plane flying. This is what taking care of someone with critical illnesses is like. It is not like flying a 737 that has had each and every critical system brought to six-sigma levels of performance before it is allowed out of the hanger.

I don’t have access to the primary data that drives estimates of hospital mortality from adverse events. But if you reviewed the charts, how many of the “medical errors” occurred in very sick patients with multiple system disease? Massive trauma? A pain medicine overdose in a healthy 37-year-old in the hospital for a hysterectomy is not the same as a pain medicine overdose in a 78-year-old with CAD and multiple myeloma who is admitted with a hip fracture. We should continue to learn whatever we can from the praiseworthy culture of safety and performance of our airplanes and pilots. But let’s not take the metaphor where it doesn’t fit, and let’s not assume that every very sick person who dies in a hospital from an adverse event is an example of a truly preventable death rather than dedicated clinicians trying their best to keep someone alive and eventually failing.

Abraham Morse is an obstetrician-gynecologist.

Image credit: Shutterstock.com

Prev

Structured settlements are ruining patients' lives

January 10, 2018 Kevin 5
…
Next

Here’s why doctors must know prescription costs

January 10, 2018 Kevin 6
…

Tagged as: Public Health & Policy

Post navigation

< Previous Post
Structured settlements are ruining patients' lives
Next Post >
Here’s why doctors must know prescription costs

Related Posts

  • How social media can help or hurt your health care career

    Health eCareers
  • Why the health care industry must prioritize health equity

    George T. Mathew, MD, MBA
  • Turn physicians into powerful health care influencers

    Kevin Pho, MD
  • What do cement trucks and health care have in common?

    C. Todd Staub, MD
  • Why health care delivery is an exceptionally different industry: health system infrastructure and health system operations and execution

    Joe Mandato and Ryan Van Wert, MD
  • Why health care replaced physician care

    Michael Weiss, MD

More in Policy

  • Unveiling the global pandemic threat: insights into risk factors and urgent measures for prevention

    Ton La, Jr., MD, JD
  • Why the WHO’s pandemic accord is critical for global health care

    Elizabeth Métraux
  • The revolutionary Kaiser-Geisinger deal: How health care giants are reshaping the industry and empowering patients

    Robert Pearl, MD
  • Unveiling the intricate link between housing costs and health care

    Harvey Castro, MD, MBA
  • Uncovering the truth about racial health inequities in America: a book review

    John Paul Mikhaiel, MD
  • Why affirmative action is crucial for health equity and social justice in medicine

    Katrina Gipson, MD, MPH
  • Most Popular

  • Past Week

    • Physician entrepreneurs offer hope for burned out doctors

      Cindy Rubin, MD | Physician
    • Boxing legends Tyson and Foreman: powerful lessons for a resilient and evolving health care future

      Harvey Castro, MD, MBA | Physician
    • Is chaos in health care leading us towards socialized medicine? How physician burnout is a catalyst.

      Howard Smith, MD | Physician
    • We need a new Hippocratic Oath that puts patient autonomy first

      Jeffrey A. Singer, MD | Physician
    • Unveiling the intricate link between housing costs and health care

      Harvey Castro, MD, MBA | Policy
    • Breaking free from restrictive covenants to combat burnout

      Raya E. Kheirbek, MD | Physician
  • Past 6 Months

    • It’s time to replace the 0 to 10 pain intensity scale with a better measure

      Mark Sullivan, MD and Jane Ballantyne, MD | Conditions
    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
    • Revolutionize your practice: the value-based care model that reduces physician burnout

      Chandravadan Patel, MD | Physician
    • Unveiling the hidden damage: the secretive world of medical boards

      Alan Lindemann, MD | Physician
    • An inspiring tribute to an exceptional radiologist who made a lasting impact

      Kim Downey, PT | Conditions
  • Recent Posts

    • Breaking free from restrictive covenants to combat burnout

      Raya E. Kheirbek, MD | Physician
    • Fixing the system and prioritizing patient care [PODCAST]

      The Podcast by KevinMD | Podcast
    • From medical student to intern: Discovering a deeper connection with patients

      Johnathan Yao, MD, MPH | Physician
    • A physician’s typical day, as envisioned by a non-clinician health care MBA: a satire

      Jennifer Lycette, MD | Physician
    • Unveiling the global pandemic threat: insights into risk factors and urgent measures for prevention

      Ton La, Jr., MD, JD | Policy
    • Decoding name displays in health care: Privacy, identification, and compliance unveiled

      Deepak Gupta, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 10 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • FDA Allows Chemo Imports from China; TB Patient Jailed; 'Forever Chemicals' Lawsuit
  • Novel IDH1/2 Inhibitor Shows 'Dramatic Effect' in Low-Grade Glioma
  • Nivolumab-AVD Boosts PFS in Untreated Hodgkin Lymphoma
  • 'You Can't Yoga Your Way Out of This': What We Heard This Week
  • New Standard in Operable EGFR-Positive Lung Cancer

Meeting Coverage

  • Novel IDH1/2 Inhibitor Shows 'Dramatic Effect' in Low-Grade Glioma
  • Nivolumab-AVD Boosts PFS in Untreated Hodgkin Lymphoma
  • New Standard in Operable EGFR-Positive Lung Cancer
  • New Ovarian Cancer Drug Extends Survival in Resistant Disease
  • Neoadjuvant Chemo Flops Versus Upfront Surgery for Resectable Pancreatic Cancer
  • Most Popular

  • Past Week

    • Physician entrepreneurs offer hope for burned out doctors

      Cindy Rubin, MD | Physician
    • Boxing legends Tyson and Foreman: powerful lessons for a resilient and evolving health care future

      Harvey Castro, MD, MBA | Physician
    • Is chaos in health care leading us towards socialized medicine? How physician burnout is a catalyst.

      Howard Smith, MD | Physician
    • We need a new Hippocratic Oath that puts patient autonomy first

      Jeffrey A. Singer, MD | Physician
    • Unveiling the intricate link between housing costs and health care

      Harvey Castro, MD, MBA | Policy
    • Breaking free from restrictive covenants to combat burnout

      Raya E. Kheirbek, MD | Physician
  • Past 6 Months

    • It’s time to replace the 0 to 10 pain intensity scale with a better measure

      Mark Sullivan, MD and Jane Ballantyne, MD | Conditions
    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
    • Revolutionize your practice: the value-based care model that reduces physician burnout

      Chandravadan Patel, MD | Physician
    • Unveiling the hidden damage: the secretive world of medical boards

      Alan Lindemann, MD | Physician
    • An inspiring tribute to an exceptional radiologist who made a lasting impact

      Kim Downey, PT | Conditions
  • Recent Posts

    • Breaking free from restrictive covenants to combat burnout

      Raya E. Kheirbek, MD | Physician
    • Fixing the system and prioritizing patient care [PODCAST]

      The Podcast by KevinMD | Podcast
    • From medical student to intern: Discovering a deeper connection with patients

      Johnathan Yao, MD, MPH | Physician
    • A physician’s typical day, as envisioned by a non-clinician health care MBA: a satire

      Jennifer Lycette, MD | Physician
    • Unveiling the global pandemic threat: insights into risk factors and urgent measures for prevention

      Ton La, Jr., MD, JD | Policy
    • Decoding name displays in health care: Privacy, identification, and compliance unveiled

      Deepak Gupta, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Health care and the airline industry have a lot in common
10 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...