I am standing before a team of fellows, residents, medical students, and pharmacists on Monday morning about to start rounds on the oncology service. And as the intern is about to dive into the first patient presentation, I take a moment to ask a question: “Is anyone here into aviation?” This context is met with an awkward pause, people’s eyes looking down, and a bit of confusion. I make an analogy to the team that while I may be like a pilot helping to guide us to our destination, trying to assure safe and efficient patient care, everyone has a voice and should not hesitate to speak up.
One of my guilty pleasures during pandemic lockdowns has been learning more about aviation. So I could go on talking more to the team about the comparisons between medicine and the airline industry, but we have patients to see and some to discharge before noon.
I thought I would use this opportunity to review ten analogies I have noticed between medicine and the airline industry.
1. Crew resource management. One reason why modern commercial aviation is safer is that pilots have more information at their fingertips in the event of an emergency. Crew resource management is essentially using all information available from all crew members, not just the pilots, to gather information and make decisions in an emergency.
On a medical team, I value the input of the lowest ranking members of the team, typically the medical students, as much as the higher ranking ones. It is important that everyone has a voice since as much as the flight attendants have a better view of an engine fire, the medical assistants may have a better sense of a patient’s daily habits than do the doctors who see the patient less frequently.
2. Customer service. You may have noticed that tensions tend to be high among some modern airplane passengers. It is difficult to please everyone, even with staff acting professionally. Likewise, in health care, it is impossible to satisfy every patient or their family members.
At best, we improve health, change lives for the better, and overcome some of the socioeconomic barriers that lead to health care disparities. But with the ever-growing complexity of clinical care and the many different challenges among those who board a health care flight, there will always be upset passengers. We try to be respectful and do the best we can.
3. Redundancy. Flying is safer nowadays due to a series of redundant systems (e.g., two pilots, two engines, a backup power source called the auxiliary power unit, and many other examples). In medicine, we have checks in place that try to assure safety, such as co-signatures for certain medications, warning notifications in the electronic record, and various staff looking over orders, such as pharmacists and nurses. As in flying and medicine, these systems are not perfect, but they prevent some errors.
4. Expensive tools. Pushing the thrust levers to the maximum to force a multimillion-dollar airplane to rush down a runway during takeoff must be thrilling. In medicine, we also use expensive tools such as robotic surgical devices, biological therapies, and other medical devices at the forefront of health care, which are part of the privilege and thrill of being in health care.
5. Teamwork. While the pilots may get credit for a smooth landing, the fact that the flight was safe and efficient involved many unseen heroes, such as the ground crew, air traffic controllers, airplane technicians, and many others.
The more I work in health care, the more I realize it depends on an interprofessional approach, with communication being key. There is no way for me to be an expert in everything, let alone do all the tasks required to take care of patients. So I depend on many professionals, from nurses to advanced practitioners to respiratory therapists, social workers, and others, to achieve quality patient care.
6. Checklists. In the event of an emergency in flight, pilots rely on both their memory items and a series of checklists to quickly address a problem. As a medical student, when I first read Atul Gawande’s The Checklist Manifesto, I realized how important it is to have a systematic approach to patient care, particularly procedures, to avoid mistakes. I use checklists every day, some internalized and some on paper, to ensure I do not forget important tasks that need to be done for patients.
7. Training and recertification. It takes many years to become a pilot due to the need for education and real-world flight experience. In addition, pilots must be certified or subspecialize to fly a particular airplane. It takes many years to become a physician and subspecialize in one area, and we learn a great deal in practice. For example, the same goes for procedures — our oncology fellows have to be certified to perform bone marrow biopsies. Pilots spend time in a flight simulator to simulate emergencies. And in our medical school, we have a simulation lab to train for emergencies such as cardiac arrests. Keeping up to date on different skillsets is essential for patient care.
8. Getting rest. In the same way, a well-rested pilot is a safer one. A physician who is not overly exhausted due to prolonged time without sleep will be less likely to make mistakes. Pilots and air traffic controllers have limits on how much time they can work before the next shift, and likewise, house staff has work-hour regulations that mandate time off between shifts.
9. Safety. We talk about the swiss cheese model of mistakes in health care, meaning several things must go wrong for an error to occur despite all the checks. Crash investigations to unravel flight disasters are measures that seek to prevent future incidents. Likewise, having morbidity and mortality conferences, fostering a just system in medicine where staff can report errors without fear of retribution, and being forthright with patients when an error occurs are important to learn from and prevent future mistakes.
10. Healthy narcissism. The best pilots and clinicians are the ones who take pride in their work, feel as though it is a calling, are willing to accept the good and the less appealing parts of the profession, make sacrifices, and still love what they do.
None of the above parts of health care (or the airline industry) are perfect, but to me, while I am about to start rounds and take care of sick patients while training the future generation of clinicians, I know I have the best job in the world.
Marc Braunstein is a hematology-oncology physician and can be reached on Twitter @docbraunstein.
Image credit: Shutterstock.com
