Every so often, a wee media firestorm erupts over surprising issues. Consider surgeons, for example, who sing in the operating room. The latest eruption happened locally with the dismissal of an official complaint from a Canadian patient offended by his eye surgeon’s vocals in the O.R.
According to a report of the hearing published in The Vancouver Sun, the unnamed patient filed a complaint to the College of Physicians and Surgeons of British Columbia after the eye surgery in May, 2011. The patient (awake for his entire procedure) could hear everything. He not only objected to his surgeon’s singing during the operation, but also the fact that he was casually chatting with others in the O.R. about, for example, his plans to take home the hospital’s linens “so he could wash his car with them.”
The complainant described the surgeon’s singing and chatter as “unacceptable, arrogant, disrespectful and shameful.”
But the College dismissed the complaint. And when the patient appealed to the B.C. Health Professions Review Board, that board dismissed it, too, with both agencies referring to the patient’s complaint as “trivial”.
A spokeswoman for the College claimed that the patient’s care was not compromised by the surgeon’s conduct, although she did add that the regulatory body must still “remind doctors that they have to be professional in all interactions with patients.”
But it turns out that both the College and the review board might have been mistaken in their assumption that patient care was not affected, according to a study on O.R. distractions published in The Journal of the American College of Surgeons recently.
As reported in Fierce Healthcare, the Kentucky researchers found that background noise in the operating room, such as loud surgical tools, talkative team members or music, can “significantly impair communication among the surgical team.’
In the presence of background noise, surgeons’ speech comprehension worsens when discussions include important details that are unpredictable – especially when music is playing, according to the study. Interrupting questions caused the most problems, followed by sidebar conversations among the O.R. team.
Now, I’ve never had eye surgery. I’ve never even been to Kentucky. But I have been in my fair share of operating rooms, diagnostic labs and hospital clinics where I’ve felt uncomfortable about the medical team’s behaviour.
For example, it’s surprisingly common for a medical team to “talk over” the patient, almost as if the patient were merely a piece of meat on a slab – but worse, an invisible piece of meat who just happened to be the 10 o’clock procedure, the obstacle between staff and their next break.
As a heart attack survivor with ongoing cardiac issues, I’ve had several opportunities to lay there on the gurney feeling not only frightened about what was going to happen next, but also as if I’d inadvertently crashed a private party while the medical staff overhead chatted about their weekend plans, laughed, cracked in-jokes – and yes, sang along with that ever-present (often hideous) O.R. music.
Once the anaesthesia takes effect, I don’t mind being treated like this – because I’m out like a light.
But this Kentucky study suggests that perhaps patients should actually be more concerned about all that ambient noise that’s distracting our surgeons even while we are under.
For example, the study authors warn:
“In a setting in which crucial tasks are performed continuously, distractions and barriers to communication can result in harm to both patients and O.R. personnel.
“It was found that the impact of noise is considerably greater when the participant is tasked. Surgeons demonstrated substantially poorer auditory performance in music.”
To prevent communication breakdowns and medical mistakes, the researchers recommend turning music off or lowering the volume, and limiting background conversations in the operating room
Another previous 2012 Oregon State University study published in JAMA Surgery found that surgical residents committed significantly more surgical errors when distractions and interruptions were introduced than during an uninterrupted procedure – in fact, eight times more errors when there were common disruptions in the O.R.
And in an interview done by the American Academy of Orthopaedic Surgeons, U.S. Army surgeon Col. Daniel White describes O.R. distractions as reaching “epidemic” levels:
“Nurses texting and playing ‘Words with Friends’, anaesthesiologists surfing the net, and alarms and notices throughout the case. All of it can be quite a distraction.
“The patient monitors and the necessary noises are enough. The louder it gets, the harder it is to communicate effectively.
“Teaching observers in the O.R. also has a distracting component, but patient safety must trump all distractions, including ‘intended distractions’ like teaching.”
In the same interview, Dr. William Robb, founder of the Illinois Bone and Joint Institute, listed a number of recommendations from an American College of Surgeons position paper on operating room safety:
- leave pagers and cell phones outside the O.R. or turn them to silent mode
- no web surfing, text messaging, or cell phone conversations in the O.R.
- no loud or distracting music
- only pertinent conversation from the anaesthesia team related to the case (the banter between the anaesthesia, surgery, and/or nursing teams needs to be related to the surgical care)
- limiting all non-essential conversation to maintain the central focus of the surgical team (non-essential conversation degrades the environment and is distracting)
Already, I can imagine the dismissive harrumphing* from some surgeons reading this, particularly as it’s delivered by a lowly patient who’s fast asleep during much of our relationship.
But as The American College of Surgeons once advised med students considering a surgery residency:
“Thoughtful reflection on the outcomes of your decisions and those of others will give you the most important quality: good surgical judgment.”
So while you’re thoughtfully reflecting on the recommendations of the Kentucky study among others, and thoughtfully reflecting on whether it’s time to dial down all preventable noise in your O.R., here’s a question related to both common courtesy and patient safety:
Would it be too much to ask that at least one – not everybody, but even just one – team member be assigned the bedside manner role of placing one reassuring hand on the patient’s shoulder, actually talking and listening to the patient in the midst of all the team socializing going on around us – at least until the anaesthesia kicks in?
You know, as if the patient were a living, breathing, human being just like the people standing over us, singing?
* harrumph: verb \hə-ˈrəm(p)f\ “To grumpily express dissatisfaction or disapproval.”
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