NO JS to anti-ALPA types

[JPAustin]

It's so nice to see a post with reason and logic!! Totally agree!

Many thanks to you.

 

[yahooair]

what you are really saying: I DONT WANT ANY SKYWEST PILOTS ONBOARD MY A/C/ ILL SHOW EM...DONT CARE IF THEY ARE ALPA VOTERS OR NOT, I HATE MY LIFE AND THIS INDUSTRY SO MUCH I NEED TO TAKE IT OUT ON SOMEONE,,,I HATE THE DECISION I MADE WITH MY LIFE...
pookie dont be a puss* where do you work? so i can make sure we dont allow any of you guys on our a/c....lets do this.
its time for war

 

[Rez O. Lewshun]

As usual Soverytired and Joe Merchant-wrong!

Unions are just terrible at self-policing.

Pilot unions, to my knowledge, have no such boards or self-policing powers, to the ultimate detriment of the entire group.

It seems you just think unions and ALPA suck... and your buddy hater Joe Merchant who is so in love with the profession of lawyers and doctors...

Rather..why not look in our own house and start to clean up...

http://www.usatoday.com/news/health/2007-12-03-doctor-standards_N.htm#

Study: Doctors don't always report colleagues, errors

By Rita Rubin, USA TODAY
Although virtually all doctors think they should report impaired or incompetent colleagues or serious medical errors to the relevant authorities, nearly half don't, a study suggests Monday.
The authors say they are the first to try to broadly assess doctors' support for and adherence to professional standards. The researchers, whose findings appear in the Annals of Internal Medicine, surveyed a national random sample of 3,504 practicing doctors between November 2003 and June 2004. They received responses from 1,662.
While 96% of respondents said doctors should always report impaired or incompetent colleagues, only 55% of those with direct personal knowledge of such doctors in the past three years said they always did so.
And while 93% of respondents said doctors should always alert authorities when they observe serious medical errors, only 54% of those who had such information in the past three years said they always did so.
"I think human beings always fall short of their aspirations," senior author David Blumenthal says. "The intent of the paper was not to criticize but to … highlight the areas for improvement."
FIND MORE STORIES IN: Cardiology
Blumenthal, a Harvard internist who directs Massachusetts General Hospital's health policy institute, said he was encouraged that virtually all respondents supported professional standards. "You don't have to convince them about what they ought to be doing," he says.
Of the specialties surveyed, cardiologists were the least likely to say they always reported direct knowledge of a serious medical error. And, by just 0.8%, cardiologists were second only to family practitioners in being least likely to report an impaired or incompetent doctor. Anesthesiologists, surgeons, internists and pediatricians were also surveyed.
Jack Lewin, CEO of the American College of Cardiology, says most cardiologists, unlike most doctors, practice in groups. Instead of reporting impaired colleagues or serious mistakes to outside authorities, cardiologists are more likely to deal with such problems inside their practices, Lewin says. In addition, he says, many doctors fear being sued if they report incompetent colleagues. "We probably need some kind of whistle-blower protection for doctors."
However, Blumenthal's study found that doctors who practiced in groups of at least three were more likely than other doctors to say that they always reported an impaired or incompetent colleague or a serious medical error.
The other main discrepancy between what doctors said they believe and what they said they practice related to distribution of health care resources.
Nearly all said doctors should minimize disparities due to race or gender. But a third said they would give in to a patient who demanded an MRI because of back pain that was likely to go away on its own.
"There's a lot of pressure on physicians to keep their patients happy," Blumenthal says. "Part of the problem with the American health care system has been that there is no throttle on test-ordering."

 

[Rez O. Lewshun]

Here is more....

Doctors must double-check before surgery
WASHINGTON (AP) — Starting July 1, operating rooms are supposed to be a little safer: Surgical teams must take new steps to prevent operating on the wrong body part or wrong patient.
Among the requirements: Much as airline pilots go through a safety checklist before takeoff, surgeons and nurses must take what's being dubbed a "time-out" before cutting. It's to double-check that the right patient is on the table, if he's really to lose a kidney and not a gallbladder — and if so, on which side.
Hospital regulators hope the new rules will finally put an end to growing reports of wrong-site, wrong-procedure and wrong-patient surgeries.
"These should never happen," says Dr. Dennis O'Leary, who heads the Joint Commission on Accreditation of Healthcare Organizations. The agency can revoke the accreditation of hospital or other surgical sites that don't comply with the new safety steps.
This isn't wrong surgery because of a misdiagnosis, but mixups inside the operating room. In one infamous 1995 case a doctor amputated Willie King's wrong foot; indeed, the mixups are thought to be most frequent in orthopedic surgery.
But reports range the gamut from removing the wrong organ to drilling into the wrong side of a patient's skull to a recent case where the wrong patient was given a heart catheterization.
No one knows exactly how many such wrong surgeries occur, because the commission receives only voluntary reports, although they're a small fraction of the nation's 70 million annual surgeries.
Still, despite issuing two warnings to hospitals and surgical centers in recent years, the regulatory agency knows of 275 cases since 1999 — a steady increase each year and a problem it calls undoubtedly undercounted.
Consider the rushed pace of many operating rooms, where it's easy to wheel in the wrong patient from a queue of waiting stretchers, or to position X-rays backward as bustling workers ready dozens of high-tech gadgets.
"People should not underestimate the potential for confusion," O'Leary says. "The fact that you have M.D. or R.N. after your name doesn't keep you from making mistakes."
His regulatory agency is betting that if surgical teams have a mandatory system of double-checks, they can catch mixups before a patient is harmed. Among the rules:
• The surgeon must literally sign the incision site, while the patient is awake and cooperating if possible, with a marker that won't wash off in the operating room.
• Some doctors, and patients themselves, already do that voluntarily, but regulators found a confusing hodgepodge of styles. An "X" can mean "operate here" or "not here," and writing out "not this knee" backfires if the "not" gets smudged. So, don't place any mark on a non-operative site, the new rules stress. Avoid "X" in favor of doctor initials or some other mark used hospital-wide.
• The entire operating team must stop all other work just before surgery begins and go through a checklist to ensure the correct patient is on the table, and that everyone — surgeons, nurses, anesthesiologists, technicians — agrees what procedure is being done, on what body part. Have a system to resolve any confusion.
"My rule was you do not hand a knife to any surgeon until everything's cleared up," says Tom McLaren, surgical services administrator at Florida's Tallahassee Memorial Healthcare.
That rule averted one disaster at his previous hospital, McLaren recalls: A surgeon was ready to slice into a right kidney while a nurse argued for the left one. Technicians pulled back the scalpels as the frustrated doctor pointed to the posted X-ray — which a radiologist later noticed was placed backward.
"Many people believe, 'This could never happen to me, that happens somewhere else,'" laments Bill Duffy, president of the Association of periOperative Registered Nurses.
But there's growing awareness that any health worker can make such a mistake, and more than 40 medical organizations, such as the American Academy of Orthopaedic Surgeons and Duffy's nursing group, now have signed on to help the accreditation commission teach the new rules.
O'Leary also has some consumer advice: speak up if you're about to be anesthetized without seeing signs that the surgical team has double-checked your identity and your surgical site.

 

[Rez O. Lewshun]

More leadership from Pilots for Doctors...

http://www.nytimes.com/2006/10/31/he...=1&oref=slogin

October 31, 2006

What Pilots Can Teach Hospitals About Patient Safety

By KATE MURPHY
Wearing scrubs and slouching in their chairs, the emergency room staff members, assembled for a patient-safety seminar, largely ignored the hospital’s chief executive while she made her opening remarks. They talked on their cellphones and got up to freshen their coffee or snag another danish.

But the room became still and silent when an airline pilot who used to fly F-14 Tomcats for the Navy took the lectern. Handsome, upright and meticulously dressed, the pilot began by recounting how in 1977, a series of human errors caused two Boeing 747s to collide on a foggy runway in the Canary Islands, killing 583 people. Riveted, a surgeon gripped his pen with both hands as if he might break it, an anesthetist stopped maniacally chewing his gum, and a wide-eyed nurse bit her lip.

An attention grabber, yes, but what does an airplane crash have to do with patient safety?

A growing number of health care providers are trying to learn from aviation accidents and, more specifically, from what the airlines have done to prevent them. In the last five years, several major hospitals have hired professional pilots to train their critical-care staff members on how to apply aviation safety principles to their work.

They learn standard cockpit procedures like communication protocols, checklists and crew briefings to improve patient care, if not save patients’ lives. Though health care experts disagree on how to incorporate aviation-based safety measures, few argue about the parallels between the two industries or the value of borrowing the best practices.

Spurred by a 1999 report by the Institute of Medicine, an arm of the National Academies, titled “To Err Is Human,” which estimated that as many as 98,000 patients die annually from preventable medical errors, and by more recent bad publicity from mistakes like amputations of the wrong limbs, many health care providers are redoubling their efforts to improve patient safety.

“We’re where the airline industry was 30 years ago” when a series of fatal mistakes increased scrutiny and provoked change, said Dr. Stephen B. Smith, chief medical officer at the Nebraska Medical Center in Omaha, the teaching hospital for the University of Nebraska.

It is well established that, like airplane crashes, the majority of adverse events in health care are the result of human error, particularly failures in communication, leadership and decision-making.

“The culture in the operating room has always been the surgeon as the captain at the controls with a crew of anesthesiologists, nurses and techs hinting at problems and hoping they will be addressed,” Dr. Smith said. “We need to change the culture so communication is more organized, regimented and collaborative, like what you find now in the cockpit of an airplane.”

After the Canary Islands accident, NASA convened a panel to address aviation safety and came up with a program called Cockpit or Crew Resource Management. The Federal Aviation Administration requires that all pilots for commercial airlines and the military undergo the training. They learn, among other things, to recognize human limitations and the impact of fatigue, to identify and effectively communicate problems, to support and listen to team members, resolve conflicts, develop contingency plans and use all available resources to make decisions.

Recognizing the positive impact of the program on the aviation industry’s safety record, the Institute of Medicine in 2001 recommended similar training for health care workers. The National Academies, the Agency for Healthcare Research and Quality and the Institute for Healthcare Improvement also advocate the training, as well as the use of other aviation-inspired practices like pre- and post-operative briefings, simulator training, checklists, annual competency reviews and incident reporting systems.

The British medical journal BMJ, The Journal of the American Medical Association and The Journal of Critical Care have also published research suggesting that hospitals that adopt these measures have fewer malpractice suits and postsurgical infections. Patient recovery times tend to be lower, and employee satisfaction is higher.

With these endorsements, and with the airline industry cutting salaries, benefits and flight time, many pilots have become part-time health care consultants. For fees that range from $7,000 to $40,000, they offer training and help devise and put in place systemwide safety protocols and procedures. Among the growing number of health care institutions that have hired aviation consultants or adopted aviation safety practices in the last five years are Vanderbilt University Medical Center; Johns Hopkins Medical Institutions; Cedars-Sinai Medical Center in Los Angeles; Vassar Brothers Medical Center in Poughkeepsie, N.Y.; the University of Nebraska; and the University of Texas Medical Branch at Galveston.

“The trend is not surprising given the similarities between health care and aviation,” said Dr. David M. Gaba, associate dean of immersive and simulation-based learning at the Stanford University School of Medicine in Palo Alto, Calif.

“Both involve hours of boredom punctuated by moments of sheer terror,” he said.

In addition to sometimes having to make life-and-death decisions in seconds, pilots and physicians also tend to be highly skilled, Type A personalities, who rely heavily on technology to do their jobs.

Even so, some hospital administrators and experts in human factors argue that aviation safety principles are not wholly transferable to health care. “Medicine is a more complex environment with more professionals interacting than in aviation,” said Robert Helmreich, professor of psychology at the University of Texas at Austin and director of its Human Factors Research Project, which studies team performance and the influence of culture and behavior in aviation and health care.

The definition of an error in health care, Professor Helmreich said, is “fuzzier” than in aviation, where it is easier to identify a “foul-up” and who was responsible. Health care providers’ fear of litigation and losing their medical licenses also hinders the honest reporting of mistakes, whereas aviators are often inoculated against punishment if they promptly report incidents to the authorities. Training programs developed by pilots without knowledge of health care realities can be “appallingly bad,” he said.

More successful are programs developed by consulting firms like LifeWings in Memphis and the Surgical Safety Institute in Tampa, Fla., both of which have professional pilots and physicians developing their training materials and serving on their advisory boards.

Some institutions, like Johns Hopkins, have created their own in-house training programs and safety structures based on aviation. “Aviation provided us with the ideas, which we then modified for health care as well as our particular situation,” said Dr. Peter Pronovost, the director of the Center of Innovation in Quality Patient Care at Johns Hopkins.

Employees who work at hospitals that have adopted these kinds of aviation-based safety programs are mostly enthusiastic. Many say they are more confident doing their jobs thanks to posted checklists, which, for example, include reminders to wash their hands, confirm the identity of the patient and check for drug allergies. They appreciate the fact that they are now not only encouraged to speak up if they are concerned about something, but also required to do so.

 

[Rez O. Lewshun]

It seems the Air Line Pilot profession has allot to show doctors... you guys have no clue... the Doctor profession is in real peril.... quite looking to the other side of the grass.... it isn't greener...

Gear Up - October 2006
By Dick Karl
September 2006​

[FONT=Verdana, Arial, Helvetica, sans-serif]The Practiced Art of Airline Safety ​

​

[FONT=Verdana, Arial, Helvetica, sans-serif]10:15 a.m., eastern daylight time. The air is cool and quiet, save for the rustle of the drapes and the ripping noise made by Sabra as she opens some suture packs. Cindy is busy setting up her Mayo stand, upon which she has arranged a collection of shiny surgical clamps, two scalpels, some sutures and some silk ties. She has carefully counted the sutures and the instruments, too.[/FONT]
[FONT=Verdana, Arial, Helvetica, sans-serif]I watch with absent thought as Janet paints the patient's right chest with Betadine solution. Things are going well, we started on time and the first part of the operation has gone well. Soon I will be looking at this young man's heart and freeing his esophageal tumor from his thoracic aorta. This is my usual world, I am at home here.[/FONT]
[FONT=Verdana, Arial, Helvetica, sans-serif]Suddenly I am overtaken by a series of other images, ones I saw just a week ago. They are sights I saw in fellow columnist Les Abend's world. Since I love aviation and surgery, and because I've developed an interest, some say an obsession, with the application of aviation safety techniques in the surgical environment, those images are now superimposed onto the draped patient before me.[/FONT]
[FONT=Verdana, Arial, Helvetica, sans-serif]Les had arranged for me to travel with him on a four-day trip. American Airlines had obtained permission from the Federal Aviation Administration for me to sit in the jumpseat and watch the way the pros practice safety. Those four days will be forever tattooed in my visual, aural and emotional memory. For a lifelong airline pilot aspirant, the adventure was so rich, so succulent, that I am speechless when it comes to thanking Les, the FAA, American Airlines and its chief pilot, Mark Hetterman, and its CEO, Gerard Arpey, the man who gave us the green light. In the post-9/11 world, it took a lot to make it happen.[/FONT]
[FONT=Verdana, Arial, Helvetica, sans-serif]But happen it did. The differences between Les's environment and mine were many and the experience has sobered me about the safety work we have left to do in surgery. From the airline pilot's sign-in to the final after shutdown checklist, aviation has got plans and backup plans that are far more evolved than those we have in the operating room.[/FONT]
[FONT=Verdana, Arial, Helvetica, sans-serif]Here's what I saw over those four magical days. We started with a sign-in one hour prior to departure. In the operations area Les called up the flight plan, departure, en route and arrival weather and printed it out. The final document was a strip of paper approximately nine feet in length. Les expertly folded the pages into a coherent set of useful chunks of information, then, in a practiced way, tore along pre-perforated lines to separate the sheets into several packets of data.[/FONT]
[FONT=Verdana, Arial, Helvetica, sans-serif]I can't tell you that I ever fully comprehended all of the items that he printed out, but I do know that there was a lot of information there. Our first flight was from Fort Lauderdale to San Juan, Puerto Rico, a distance of 908 nautical miles. The flight plan included the route, the latitude and longitude of each waypoint, the expected time of waypoint passage, the fuel remaining at each point, the predicted takeoff weight and total fuel on board. That total fuel was calculated to include the predicted fuel burn en route, taxi allowance, reserve and alternate provisions and fuel to hold. Our alternate was Santo Domingo, Dominican Republic. Les took the total fuel on board, subtracted the reserve and alternate amount and divided the rest by 130 lbs of jet-A per minute of flight. He calculated we had another 50 minutes of gas, which he called his "play around" reserve. He seemed satisfied.[/FONT]
[FONT=Verdana, Arial, Helvetica, sans-serif]That was just three feet of the printed information and Les carefully reviewed the remaining six. There he found notams, winds aloft, a list of American's minimum equipment list (MEL) revisions, a note about the need to establish communications with Havana ATC 10 minutes prior to entering their airspace, a lengthy text description of the prog chart, runway conditions, frequencies for a variety of services (ATIS, FBOs, etc.), deicing conditions (it was hot everywhere), the names of all crewmembers and their nicknames, and the V speeds for each runway. I'm sure there was more that I couldn't decipher.[/FONT]
[FONT=Verdana, Arial, Helvetica, sans-serif]There was a note about being sure to turn off the center tank fuel pumps when the tank held less than 1,000 lbs of fuel, a lesson learned from the analysis of the TWA 747 that blew up over the Atlantic Ocean en route from New York to Paris. During our four-day trip the 10th anniversary of that accident occurred, reminding all of us that aviation, though safe, can be dangerous.[/FONT]
[FONT=Verdana, Arial, Helvetica, sans-serif]It was time to board American's elegantly shaped and traditionally painted 757. Les introduced me to Robert Wall, our first officer. We had our first of many lengthy conversations with gate agents; they were all very suspicious of a jumpseater not in uniform and without an ID. I produced a very official looking slip sent to me by American entitled "Admission to Flight Deck." It carried the signatures of the chief pilot and of the principal operating inspector (POI). In a way each of these encounters was reassuring: American is very particular about who sits in their cockpits.[/FONT]
[FONT=Verdana, Arial, Helvetica, sans-serif]Safety emphasis was everywhere. The airplane had just come from our destination, San Juan, and Les made sure to ask the incoming crew about the flight conditions they had just encountered and the airplane they had just flown. It took only a minute, but it spoke volumes.[/FONT][/FONT]

 

[Rez O. Lewshun]

cont....

Les volunteered to do the walk-around and I had hopes of doing it with him. But a ramp agent quickly pointed out that I didn't have an employee badge and that the Broward County Police would soon be on the scene were I to participate. "They'll rip my badge off me and I'll be out of work," he said. I was disappointed and reassured at the same time.
Back on board, Les gathered the flight attendants around him just outside the cockpit door, introduced me and Robert to everybody and reviewed the procedures for entering the cockpit. I can't tell you what they are, but I can tell you that you can't just knock and get in. Les reviewed what the plan was for an emergency. "If there's a fire, I'll tell you which doors not to use. So if you can't hear everything, but you hear left over wing, don't open that exit. If you see a man in an asbestos suit, try to catch his attention." We all listened with rapt attention.
Once in the cockpit, I settled into one of the two jumpseats. There I watched two pros get ready for some over-water night flying. They reviewed the route, entered it into the Flight Management Computer (FMC), cross-checked each other and set the proposed bug speeds for takeoff. Les briefed Robert as to what to do if we had an emergency on takeoff. Since it was Robert's leg, Les proposed a return to the field that would leave the airport visible out of Robert's side of the cockpit. A small thing to be sure, but quiet evidence of forethought.
Robert and Les remembered the protocol for that center tank pump drill slightly differently. Instantly, Les hauled out the operations manual and showed Robert the exact wording of the plan. I was to see them show each other texts many times over the next few days—usually final takeoff weights, V speeds and flap settings. Rather than being reluctant to consult the ops manual, both pilots seemed eager to precisely remind themselves of the exact procedure. American Airlines doesn't raise cowboys, they train pilots. We do so little of this in medicine, I found myself thinking. Push Back. 187 souls were now entrusted to two men. Each pilot looked out his side window, extending a thumb up to signify that they saw no obstruction to aircraft movement. The air crew alert and reporting system (ACARS), via a small little printer right in front of me, now spit out the "Load Closeout" comprised of a final passenger count, takeoff weight, fuel on board weight and the zero fuel weight, among other things.
Robert read the checklist. Once again the V speeds, stabilator setting and power settings were rehearsed. Les said, "Starting number L." He reached up, set the left engine to "GND" and, when acceptable N2 and N3 figures were met and the EGT fell below 100, Robert flipped the fuel control to run. With both running we were cleared to taxi. Our four-day trip was starting on time. "Flaps 15," said Les. Robert positioned the flap lever, watched the indicator and when he was satisfied that they were indeed not just set, but actually deployed, said, "Flaps 15 and checked." After that, he put the flight controls through their travels and we all watched on the screen as the indicators moved appropriately. We were underway.
American has a simple mechanical checklist bolted to the left of the copilot's flight instruments. It is straightforward, easy to see, illuminated. As we taxied out, we worked our way through the list, which contained about 10 items. Each item is familiar to any pilot. The only difference was our takeoff weight: 217,000 pounds.
The whole feeling of this flight deserves its own detailed description, but the safety aspects are the focus of this piece. The takeoff, call outs, and gear and flap retraction all occurred quickly and without hesitation. Robert and Les had done this before and they had, this month, done it together before. The atmosphere was a combination of alertness and banality.
Out of 10,000 feet, Les signaled the flight attendants by cycling the seat belt sign switch; the ACARS extruded a strip of paper like a child sticking out his tongue. Les tore it off and handed a copy to Robert. It had our out and off times, a recalculated time of waypoint passage and recalculated fuel remaining at each waypoint. Both pilots put a copy on their yokes and on each and every flight I would watch them each religiously write down the actual time of passage and fuel remaining. Any discrepancy would have triggered action long before a crisis became evident. Over the next four days I would watch Les and Robert nail bug speeds, fly conservatively around any suspicious splotches on radar, check frequently with ATC about ride reports, weather and short cuts, honor each and every checklist and procedure, kid each other in innocent but familiar ways, and land on speed and on target over and over. I came to appreciate the feeling of family among American's people. The airline lost two crews on September 11th and their anti-terrorism procedures are impressive. I'd love to tell you about them, but the FAA, Department of Homeland Security, the airline and my mother would disapprove. Suffice it to say that every anti-terrorist device and procedure that I had ever read about or heard about, I saw on the trips I took. I was deeply impressed by the airline's commitment to safety.
Back in the operating room, while closing the chest, I'm thinking of everything I saw on my adventure on American. From visiting Les's world, I see how far we've got to go in surgery in order to reach the level of precision, the culture of communication, and the commitment to safety that we all take for granted when boarding an airliner. Thinking back to those four magical days, I can't wipe the grin off my face. Good thing I'm wearing a mask.

 

[PCL_128]

One of the former PCL Pro-Stands reps (moved on to a major a few years ago) used to do some consulting work on the side with a company that taught CRM skills to doctors, nurses, etc... The company was all current and former airline Captains. Seems that the medical industry is still living in the dark ages as far as CRM is involved, and it's causing all kinds of accidents in the ER and OR.

 

[Airline Driver]

20 pages and counting :nuts:. must be a new board record!!! uke: