As you have most likely heard, a Boeing 737 Max 8 crashed recently in Ethiopia and all on board perished. The Ethiopia crash was the second such craft to crash at takeoff in a relatively short period of time. Worldwide, the Boeing 737 Max 8 is now grounded as a consequence of two crashes. Alarmingly, the sheen on the touted airline industry culture of safety might be more myth than reality. Mistakes were made, compromises occurred, and people died. Although it is clear that travel by air is still safe in America, it remains to be seen how deep the airline culture of safety is and if it will do what is necessary to continue to enjoy the positive reputation. The most dangerous part of flying is still the airport drive. As a physician, I think a lot about the culture of safety. Medicine has been concerned with safety for thousands of years. From antiquity, doctors were directed to first of all, do no harm. Upon reflection, I have always considered this mandate an astounding way for medicine to start, yet this phrase was as true then as it is now. Concerns for safety and quality permeate the fabric of medical practice. The airline industry is now under scrutiny while the auto industry might still get a pass. Should our healthcare system get the same scrutiny? If commercial air travel operated like medicine, the following would also be true: Passengers would struggle to only fly on planes that had pilots whom they had heard of before. Pilots would fight with each other, sometimes in front of passengers. When the plane landed, the pilot would be the first to exit the plane and would not address passengers as they left the plane. Pilots would demand special equipment for particular planes that they would fly and would only fly on specific planes that stocked the equipment in question. During certain times of year, no flights would be available, as pilots would be attending special meetings. Pilots would offer special seats and reduced fares to personal friends or famous passengers. On a daily basis, flight arrival and departures would be frequently incorrect. Sometimes passengers would be asked to arrive many hours before flights, not be permitted to eat while waiting, and then have the flight canceled without warning or explanation. Pilots would not follow standard operating procedures and instead conduct themselves in any fashion that they believed to be correct. No one would challenge them. Pilots could fly for 36 hours straight with no relief. Pilot trainees, sometimes with very little experience, and with very little supervision, would fly planes. Passengers would have no knowledge of this. Senior pilots would berate pilots in training, occasionally in front of passengers. Senior pilots would demand the most favorable takeoff and landing priorities. Passengers would be required to wait on planes until the pilot arrived. The price of tickets would be unknowable at the time of ticket purchase and would be subject to change without warning. Passengers would receive bills in the mail for weeks or months after the flight. It would be very difficult for passengers to get information on the particulars of fees. Sometimes if a passenger complained, the fee would be reduced. Individuals dressed as pilots with minor differences to the pilot uniform would sit in the cockpit and sell pilots new features on the aircraft while the aircraft was flying. When a plane crashes, the dramatic loss of so many lives at once makes headlines around the world. Many people die in hospitals and those stories are not front-page news. To an extent, exercises in safety are the stories of future success through present day failures. Public tolerance for plane crashes is exceedingly low and yet public tolerance for medical related death is exceedingly high. Commercial air travel has taught us to expect a safe arrival. Medical practice has convinced the public to have no such expectation. To be fair, human mortality is 100%, and medicine makes no claim with respect to preventing death in perpetuity. If medicine aspires to be truly safe, it must take the nature of the practice of medicine much more seriously. To wit, commercial air travel is not referred to as the practice of flying. Joel Zivot, MD, is fellowship director in critical care medicine at Emory University School of Medicine in Atlanta. His clinical expertise and research interest includes care of critically ill patients in the OR and ICU, education, and scholarly work in bioethics, the anthropology of conflict resolution, pharmaco-economics, and a variety of topics related to anesthesiology/critical care monitoring and practice. Source
