Prescription for faulty communication in operating rooms: Be explicit, not polite, study shows

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LAWRENCE — Research by a University of Kansas linguist and University of Missouri-Kansas City physicians pointed to the potential medical harm of ambiguous communication in operating rooms that also complicated the training of surgeons.

The analysis was based on observation of surgical residents at University of Pittsburgh Medical Center in which 3,912 instances, or 12.3 per minute, of imprecise language were identified during six separate surgical procedures. Restatement or rephrasing of instructions in these cases occurred at a pace of 1.4 per minute in the study.

A review of video recordings of the procedures conducted under supervision of physicians exposed 131 instances of inexact language that could have led to a medical error, researchers said.

The paper published in the Journal of Surgical Education offered recommendations for combating inexactitude in operating rooms, including the idea of emphasizing explicitness over politeness.

“We make the point in the paper that surgery is too precise to not use precise language,” said Gary Sutkin, a professor at UMKC’s School of Medicine. “A lot of it is about that polite language. I mean, we all use that polite language in our conversation. But believe me, lack of politeness will be forgiven for the sake of the patient’s health. Say what you mean. Be explicit.”

The study reinforced the perspective insufficient communication among medical team members was a contributing factor to error made in the in-patient setting. The routine use of potentially ambiguous language during surgery amplified the challenges of surgical instruction, the multidisciplinary team of researchers said.

“Sometimes it’s cutting 4 centimeters when you should have cut 3½,” Sutkin said. “But these are listed as potential near misses, as well — something that’s headed towards an error. The idea is to see if we can reduce even getting close to a near miss just by tweaking or being more attentive to the things we’re saying.”

The research paper on fuzzy phrasing was co-written by Andrew McKenzie, associate professor of linguistics at KU, and Cynthia Liu and Sutkin, both professors at UMKC.

McKenzie brought to “Semantically Ambiguous Language in the Teaching Operating Room” a terminology framework that featured 14 categories of linguistic entanglements associated with miscommunication. For example, there is imprecision about a sentence that starts and stops with “Take this over there.” It also would unclear if someone said: “Bill went home. Ted came home later. He went right to sleep.” There are multiple interpretations of those three sentences, and operating rooms were a venue where precision mattered.

The paper suggested simplistic-sounding ideas such as decking out operating rooms with signs indicating was was meant by right and left or top and bottom.

“Thousands of patients every year get hurt in the operating room because of surgeon error,” Sutkin said. “My passion is preventing those errors. Miscommunication is one of the most common causes of error in the operating room, and although miscommunication is multifactorial, I think a lot of it is the ambiguous language that we use.”

Kansas Reflector is part of States Newsroom, a network of news bureaus supported by grants and a coalition of donors as a 501c(3) public charity. Kansas Reflector maintains editorial independence. Contact Editor Sherman Smith for questions: Follow Kansas Reflector on Facebook and Twitter.

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