The Q-List Manifesto: How to Get Things Right in Generalist Medical Practice William B. Ventres, MD, MA University of El Salvador and Oregon Health & Science University Checklists have become popular in medical practice since the publication of surgeon Atul Gawande’s book, The Checklist Manifesto: How to Get Things Right. Based on his 26 years of practice as a family physician and informed by scholarly works from other professional disciplines, the author suggests that although checklists are helpful for promoting habitual reflection, they are limited in scope and meaning, and more suited for procedural undertakings than the bio-psycho-social-existential orientation of gen- eralist practice. The author reviews the characteristics of generalist practice and suggests that clinicians develop a list of questions to help them recall and examine concepts key to the exploration and management of routine and challenging situations with patients. He proposes his own Question-List, or Q-List, and recommends its adaptation for use as a manifesto to the rich and engaging work of generalist medicine. Keywords: medical philosophy, outcome assessment (health care), physician–patient relations, physician’s role, systems theory In The Checklist Manifesto: How to Get Things Right, general and endocrine surgeon Atul Gawande (2009) presents a persuasive ar- gument for the use of checklists in surgical practice. Such checklists, he argues, help main- tain safety and improve quality; they promote a habit of focusing thought and action in ex- tremely complex professional environments. Subsequent attempts at incorporating checklists on an institutional scale have proved challeng- ing, suggesting that situational milieu and rela- tional context play important roles even in the highly intensive procedural world of surgery (Urbach, Govindarajan, Saskin, Wilton, & Bax- ter, 2014). I, however, am a generalist practitioner and not a surgeon. Although I do perform office- based procedures, my work is mostly a mixture of medical decision-making and relational prac- tice. By medical decision-making, I mean lis- tening to patients’ presentations, conducting physical examinations appropriate to concerns, assessing problems from a biomedical point of view, and suggesting suitable treatment plans. By relational practice, I mean exploring psycho- logical, social, cultural, environmental, and eth- ical factors for insights into patients’ illnesses and integrating emergent understandings into functioning diagnostic assessments and thera- peutic plans. Checklists in Generalist Practice In my day-to-day work, checklists are clearly appropriate during the roughly 10% of time I devote to procedures. (Contrast this amount of time with that a typical surgeon devotes to pro- cedures, as suggested in Figure 1.) Keeping up-to-date, ready for the occasional emergency is also a vital component of my skill set and confidence under pressure. Mental checklists focusing on step-by-step algorithms for han- dling complicated medical situations, especially those that arise spontaneously under otherwise normal circumstances, have proved valuable for my patients and me. In addition, checklists are helpful in tracking immunizations and imple- menting evidence-based disease management strategies. This article was published Online First January 19, 2015. I deeply thank Carlos Criollo, MD, Richard Frankel, PhD, and Marc Tunzi, MD, for their helpful comments on early drafts of this article. Correspondence concerning this article should be ad- dressed to William B. Ventres, MD, MA, Urbanización Buenos Aires III, Block H, Calle Los Maquilishuat, N° 3-A, San Salvador, El Salvador. E-mail: wventres@gmail.com This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. Families, Systems, & Health © 2015 American Psychological Association 2015, Vol. 33, No. 1, 5–13 1091-7527/15/$12.00 http://dx.doi.org/10.1037/fsh0000100 5