The People's Therapist

Atul Gawande is a medical superstar – a surgeon at Harvard who’s also a New Yorker magazine writer, and the author of several books. His latest push is for doctors to use checklists to prevent common mistakes during surgery. A scary percentage of the time, it turns out, things grow overwhelmingly complicated in an operating room and a nurse or an anesthesiologist, or a resident (or whoever) gets distracted and forgets to do something basic – like confirm there’s extra blood in the fridge, or plug that little hose into the machine that keeps you breathing.

It happens. People forget things. Best to err on the safe side, and use a checklist.

The idea comes from aircraft pilots. It turns out they use checklists for absolutely everything – a pilot literally can’t step into a plane without a checklist. Pre-take-off, take-off, pre-landing, landing, and every possible contingency that might happen in-between is assigned a checklist. That’s because when you’re a pilot and you forget something, well…it can be a problem. Kind of like a surgeon.

Or a lawyer.

This isn’t exactly a new idea. The first thing I received at Sullivan & Cromwell when I arrived there was a checklist – and my first task was to start ticking off items. That’s how you handle a corporate deal closing – otherwise you’d never keep track of all the officer’s certificates and securities certificates and side agreements and various other bits of paper required for that six hundred million dollar acquisition of the rubber plant in Brazil (or whatever.) If you’re the junior associate and you forget something that needs to be on a closing table, well… it can be a problem.

But there’s another surprising finding in Gawande’s new book, “The Checklist Manifesto.” One required item on pilots’ checklists simply instructs them to stop and introduce themselves. During that process, they explain their responsibilities to one another, including any pertinent details regarding that specific flight. It sounds like this:

“Hi, I’m Tyrone Harris, and I’ll be pilot in control of the aircraft today for a flight to Madison on this Airbus A330-200 leaving from La Guardia airport. Weather conditions are normal but there may be some turbulence as we arrive in Madison. In case of an emergency, our initial response will be to land at Teterboro Airport in New Jersey. In case of any later unexpected event, we will be communicating directly with flight control in Columbus, Ohio for instructions.”

“I’m Norma Wong, and I’ll be the co-pilot today. I acknowledge that we are flying from La Guardia to Madison and have also acknowledged the weather conditions and our emergency plans for this flight.”

(I made all that up – I don’t know anything about flying airplanes, but you get the idea.)

Gawande translated this all-important step – the introduction and role explanation – into his checklist for surgery. Each member of the operating room staff introduces him or herself to everyone else, reviews what they are doing there that day – the nature of the operation, the name of the patient, any issues or complications that might arise and what they’ll need to know in advance to handle them.

According to Gawande, this process requires only a few minutes, and is the most important step on the entire checklist – or any checklist of this type. Its importance begins with the simple process of having the members of a team introduce themselves to one another before they begin working on a shared task. Merely knowing the names of the people you’re working with has been shown to improve the quality of the work and satisfaction of the workers in an operating room. It’s that simple – learning one another’s names and reviewing what you are doing and establishing that you are all on the same base. It’s not rocket science.

I’ve been mulling this over, and it occurs to me lawyers don’t do this. Any of it.

I remember getting “assigned” to a deal at S&C. The process was thus: the dreaded phone call arrived, you answered, and some partner you didn’t know told you to call a senior associate you didn’t know because you were on his deal. You hung up, and called the senior. He told you to come to his office, where he hunkered amid towering heaps of documents. He handed you a pile of paper and grunted an order – “take a look at this crap and make a list of blah…” or “go to the library and try to figure out what the fuck a blah is,” or the ever-dreaded “go back to your office and plan for late nights for the foreseeable future. I’ll call you when I need you.”

That was it. I generally didn’t know who the partner on the deal was, let alone the client. Obviously, I had no idea what the deal was about. And, once I received my assignment from the senior associate, I typically had no idea what I was doing.

That’s life in a big law firm.

Imagine, however, if we adopted Gawande’s checklist, and insisted all participants in the deal, or case, or whatever, gathered in a room together and emulated pilots and surgeons. It might sound a little like this:

“Hi, I’m Jane McCallister and I’m the corporate partner. We’re doing a deal for Giant Evil Bank, LLC, involving their purchase of the shares of Environmental Poisoner, Inc. To avoid paying taxes, we’re using an intentionally convoluted, quasi-legal off-shore limited partnership structure. It’s so labyrinthine our tax partner’s looking lost. I make $1.8 million per year, but desperately want to earn more and will do anything to achieve that goal.  The person I’m closest to is my cat, George.”

“Hi, I’m Moshe Horowitz, the tax partner. This deal makes me afraid, because it’s probably illegal. I’m having a hard time pushing the image out of my mind of being escorted in handcuffs by FBI agents, but the new, higher dose of anti-depressants is helping. Every cent I earn funds posh private schools in Westchester for my kids and a mortgage on the huge house my wife wanted. I rarely see the kids or the house or the wife. The person I’m closest to is my basset hound, Shlomo.”

“Hi, I’m Sam Yang, the senior associate. I don’t understand the deal, so I’m winging it, which is not atypical. My girlfriend just moved out. She said she never saw me anyway so what’s the point? Late at night I do bong hits and cruise sex sites. I owe a bank one hundred and forty thousand dollars and find myself hoping I don’t survive my next review. But then I remember how much money I owe.”

“Hi, I’m Krishna Gupta and I’m the junior. I have no idea what’s going on. I owe a bank two hundred thousand dollars. I can’t believe I have a job. I’ll do anything you ask.  Anything.”

“Hi, I’m Eduardo Garcia and I’m the paralegal.  These deals are all the same to me.  My goal is to rack up overtime so I can bank the down payment for a vintage ’92 jet black Camaro Z/28 305 T.P.I. V8 5-speed.”

“Hi, I’m Bernice Ogunde, the corporate partner’s secretary.  The partner is sleeping with a senior associate in the real estate group. I possess evidence of this affair in the form of emails I’ve copied to my home computer. Hence, I rarely show up at the office, and then I’m often drunk.”

“Hi, I’m Elaine Dogworthy, the word-processor. In real life, I’m an experimental performance artist.  In my act, I play an electric violin wearing brightly-colored paint-on latex and balance a four-foot papier-mache statue of the Hindu god Ganesh on my head.  At some point, when I book a date at an open-mike poetry slam, I’ll send you invites, which you’ll delete without opening.”

It’s that simple. Everyone takes a quick moment to introduce themselves to their colleagues, and confirm they’re all on the same page.

Voila! Increased efficiency and happiness.

All because of an item on a checklist.
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This piece is part of a series of columns presented by The People’s Therapist in cooperation with AboveTheLaw.com. My thanks to ATL for their help with the creation of this series.

If you enjoy these columns, please check out The People’s Therapist’s new book, Way Worse Than Being a Dentist: The Lawyer’s Quest for Meaning

I also heartily recommend my first book, an introduction to the concepts behind psychotherapy, Life is a Brief Opportunity for Joy

(Both books are also available on bn.com and the Apple iBookstore.)