A Medical Correlative

by admin on 06/19/2011 1:44 PM

Many patients never learn or even suspect that the CT examination, the echocardiogram, or the magnetic resonance imaging study that they underwent was neither necessary nor indicated.

Chaos in the Cockpit

Herbert L. Fred, MD, MACP
Tex Heart Inst J. 2012; 39(5): 614. PMCID: PMC3461665

On 1 June 2009, Air France Flight 447, an Airbus A330 en route to Paris from Rio de Janeiro, plunged into the south Atlantic, killing all 228 people aboard. French authorities finally concluded that the plane’s 3 pilots had not been trained adequately to fly the aircraft manually in the event of equipment failure or a stall at high altitude.

According to a report issued on 5 July 2012,1 the Bureau of Investigation and Analysis found that ice crystals had misled the plane’s airspeed sensors and that the autopilot had disconnected. Confusion heightened when faulty instructions emerged from an automated navigational aid called the “flight director.” Amid a barrage of alarms, the crew struggled to control the plane manually, but they never understood that the aircraft was in a stall and never undertook the appropriate recovery maneuvers. In fact, they followed the flight director’s instructions and went into a climb instead of into a dive, as they should have to correct a stall.

William Voss, president of the Flight Safety Foundation in Alexandria, Virginia, offered the following comment on the accident: “We are seeing a situation where we have pilots that can’t understand what the airplane is doing unless a computer interprets it for them. This isn’t a problem that is unique to Airbus or unique to Air France. It’s a new training challenge that the whole industry has to face.”

The whole healthcare industry faces training challenges that are eerily similar to those now evident in the airline industry. Indeed, we continue to graduate physicians who lack sufficient clinical skills to render good patient care without routinely reverting to and relying upon computers and other technologically advanced devices.2 In contrast to commercial aircraft accidents that typically injure or kill many people at once—and in spectacular fashion—medical misfortunes rarely make headlines. No one, for example, ever hears about the absolute halting of patient-care activities when the hospital’s computed tomographic (CT) scanner breaks down.3,4 And many patients never learn or even suspect that the CT examination, the echocardiogram, or the magnetic resonance imaging study that they underwent was neither necessary nor indicated.

Although computers and like devices offer tremendous advantages, they have important drawbacks as well. They occasionally malfunction, are not always available, and produce findings that can be misinterpreted. They have no judgment, common sense, or understanding. And they cannot reason, overcome their deficiencies, or show concern for the welfare of human beings. A well-trained doctor—or a well-trained pilot—can.5

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Address for reprints: Herbert L. Fred, MD, MACP, 8181 Fannin St., Suite 316, Houston, TX 77054
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References
1. Clark N. Report on ’09 Air France crash cites conflicting data in cockpit [Internet]
2. Fred HL. Hyposkillia: deficiency of clinical skills. Tex Heart Inst J 2005;32(3):255–7.[PMC free article] [PubMed]
3. Fred HL. The downside of medical progress: the mourning of a medical dinosaur. Tex Heart Inst J 2009;36(1):4–7. [PMC free article] [PubMed]
4. Fred HL. C.T. scanner dies. Hosp Pract (Minneap) 2001;36(1):23. [PubMed]
5. Fred HL. Gimmicks. South Med J 1983;76(8):953.

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