Checklists: from the cockpit to the radiology department.

The recent interest in using checklists to improve the quality of medical care derives, in part, from their success in aviation. Earlier in life, I had experience with checklists, and here is one vivid memory of that experience. It was a clear day over Phalsbourg Air Force Base in eastern France, many years ago. At the time, before deciding to go to medical school, I was a fighter pilot in the US Air Force there, flying F-86 Sabrejets with the 513th Fighter Interceptor Squadron. My practice mission was completed, and I flew my F-86 into the traffic pattern for a standard racetrackshaped VFR (visual flight rules) jet fighter approach. Like all my fellow pilots, I followed a mental checklist for landing. I knew the drill by heart and can still remember it clearly all these years later: Enter the pattern at 1,500-feet altitude and an airspeed of 250 knots, lined up with the landing runway. Fly one-third of the way down the runway, then roll into the pitchout, a sharp 180° turn to the downwind leg while maintaining altitude. Pull about 4 Gs in that turn, and while in it, cut the throttle to idle RPM and extend the speed brakes (doors that came out the side of the fuselage to create drag and slow you down quickly in the air). Roll out on downwind. Push the landing gear handle down to lower the gear. Push the flap handle down to lower the flaps (flaps provide more lift to the wings at low airspeed). Adjust the trim tabs. Check the indicator to make sure all 3 landing gear are down and locked. Advance the throttle to maintain an airspeed of 175 knots. Look back over your shoulder to see where the runway is and make sure you had passed beyond the landing end of it. Execute another 180° turn, this time a descending turn, to line up with the runway on final approach. Adjust the throttle to maintain 150 knots while descending on final, then flare out, throttle back to idle, and touch down. It was a mental-only checklist because things happened too fast to refer to a written list (the whole process took less than a minute). At that particular time, I was an experienced pilot and had flown this traffic pattern perhaps 250 times in fighter aircraft. It should have been a completely routine approach and landing. But as I began the second, descending 180° turn to final approach and let my airspeed slow to 150 knots, I noticed that I was losing altitude quicker than expected. So I pulled the nose up and added power to get more lift. But I was still losing altitude too fast. I pulled the nose up some more and added more power. A quick check of my engine instruments showed that the engine was operating normally. Still the toorapid descent continued. So, following my instincts, I pulled the nose up still more and added still more power. By this time, I was low to the ground and near the end of final approach with my airspeed around 180 knots (vs the 150 knots we normally flew on final), as a result of having added so much more power. In trying to get more lift and slow the descent, I had the aircraft’s nose tilted up so high I couldn’t see over it to the runway ahead. Instead, I had to look out the sides of the canopy to get visual reference to the ground. When I saw the end of the runway flash by, I pulled the throttle back to idle and let the aircraft settle on to the runway, probably going a good 40 knots faster