A catastrophe like TWA 800 or EgyptAir 990 causes air travelers to gasp at the unimaginable horror of being in such a wrong place and time. Seldom, though, does it give us much pause in booking our next reservation. We know that airplanes almost never fall out of the sky. That's why it's such big news when it happens.
In 1998 some 600 million people traveled on commercial airliners in the U.S. without a single fatality. In fact, each year more than twice as many people lose their lives on our nation's highways than have perished in airline crashes in the entire history of commercial air travel.
This is a phenomenal safety record-next to miraculous considering the complexity of the machines, the number of flights, crowded skies and scheduling pressures in this up-tempo age of ours. The general public reflexively maligns big corporations and government agencies. It's time for a public tip of the cap to the aircraft manufacturers, the airline companies, the NTSB and the FAA, with a special nod to the engineers on their respective payrolls. It's hard to imagine coming any closer to perfection, and yet the aviation industry and its regulators continue to strive for just that. Witness all their time, effort and money spent seeking needles in a watery haystack on the ocean floor in trying to figure out what went wrong with TWA 800 and EgyptAir 990.
The Bizarro WorldImagine living in a very different world. Those of you who grew up as I did reading Superman comic books might think of it as resembling that genre's "Bizarro world." This was a parallel planet inhabited by a nemesis of Superman where everything was the opposite of our reality.
In a Bizarro world, the airline industry and its regulators would do everything they could to compromise air travel safety. They might force pilots to put in Herculean hours that reduced them practically to zombies. They would scramble flight communications or ignore them. They would create a system loaded with disincentives to report malfunctions.
A ridiculous notion, of course, but believe it or not, we live in something pretty close to that Bizarro world when it comes to another industry with life and death power.
A couple of months ago the Institute of Medicine, one of our nation's National Academies created to advise the U.S. government on science and engineering issues, published a report saying that between 44,000 and 98,000 Americans die each year due to medical errors in hospitals. The upper range would rank as the fourth leading cause of U.S. deaths, following heart disease, stroke and respiratory cancers. The lower figure would put it in sixth place, ahead of auto accidents. Either statistic makes a mockery of the "do no harm" credo of the medical profession.
The Institute's report shocked many people, but not medical professionals. My late mother-in-law spent a long career as a nurse and nursing administrator. She was distinguished in her field and a warm-hearted person to whom patient care counted for everything. From her I routinely heard tales of the kind of health care follies documented by the Institute of Medicine. Additionally, I've had personal experiences of careless behavior by physicians, and I'm sure most of you have had your own.
Institutional ArroganceThe Institute's report was titled, "To Err Is Human." The implication is that medicine is not an exact science, and stuff happens.
I buy that as far as it goes. Health care providers certainly don't want to kill their patients. However, when you look closely at the abuses and neglect that permeate the field of medicine, what comes into focus is an institutional arrogance that leads to systemic flaws.
Consider the tradition of having interns work duty shifts of 24 hours and more. Ostensibly this borrows from the military philosophy of inducing fatigue and pressure in training exercises to mimic battlefield conditions. The analogy falls apart, though, in that unlike soldiers who play make-believe war games, bleary-eyed doctors in training actually get called on to perform medical procedures with life and death implications. It boils down to a reckless initiation rite that compels interns to extend themselves beyond human endurance. Just as bad, interns have easy access to medications to help them cope, and it's not exactly unheard of for some to succumb to this temptation. How'd you like to fly with a pilot whose senses are artificially stimulated by amphetamines? Think of someone in the same condition invading your body with a scalpel. It happens. More than any of us want to know.
Consider also that any number of physicians can prescribe medications and treatments without coordinating with one another. Everyone knows that even safe drugs can be lethal in combination with others, yet there is no system set up in the medical field to assure that the right hand knows what the left is doing-except for an unenforceable protocol of asking patients what medications they may be taking, which doesn't work very well with sick people who may be confused, or can't tell one complicated pharmaceutical name from another. This is the Bizarro world's version of eliminating air traffic control.
Every once in awhile you hear a horror story about a surgeon operating on the wrong patient or amputating the wrong limb. My mother-in-law asserted that these things happen much more frequently than we hear about in the media. Hospitals are supposed to have something akin to an airplane pre-takeoff checklist to guard against such errors. In the real world, even where checks exist they routinely get circumvented by all-powerful doctors who perceive themselves as too busy or experienced to be bothered with such details.
It's easy for medical professionals to rationalize bad practices. After all, they deal with people who are already sick, and often it can be all but impossible to distinguish nature's course from human error. Beyond that, they are steeped in a culture of good intentions in which medical personnel are expected to give one another the benefit of any doubt. Nobody obligates them to fill out "near miss" reports as is required of aviation personnel.
Safe vs. SorryThis essay is about more than aviation and medicine. The startling contrast in safety records between these two life-sanctioning industries holds lessons for plumbing engineers or anyone else whose work impacts human health and safety.
Your profession, like those two, is governed by codes, standards, licenses, specifications and other meticulously documented procedures intended to reduce the chance for error to as close to zero as humanly possible. But achieving that goal requires something more than words on paper.
Professional credentials and a code of ethics are only as strong as the underlying commitment. Are you so committed that you're willing to spend millions of dollars sending divers looking for bits of metal on the ocean floor? Or are you of the opinion that everyone is ultimately going to die anyway, so shortcuts are permissible? In your professional circles, is it better to be safe, or is it acceptable to be sorry?