Can language during surgery be more precise? A team of Midwest researchers think so

The language used in operating rooms isn’t always as precise as it should be and contains ambiguities that researchers want to clear up, according to a new study.

“Surgery is too precise to use imprecise language,” said Gary Sutkin, a professor of obstetrics and gynecology at the University of Missouri-Kansas City and one of the study’s authors.

The researchers found nearly 4,000 potentially ambiguous phrases in six video recorded teaching surgeries at a university medical center in Pennsylvania, or about 12 per minute of surgery.

“Language that people use in ordinary life is very ambiguous. It’s very vague, and we just kind of live with that . . . But as it turns out, that’s also the case in a surgical education environment,” Andrew McKenzie, an associate professor of linguistics at the University of Kansas and one of the study’s authors, said. “The language [surgeons] use is no more precise than the language that we would use in a casual conversation.”

None of the phrases resulted in a medical error, but the study documented 131 “near-misses” or instances that could have led to an error.

“The point of this [study] should by no means be that, ‘Oh my God, doctors don’t know how to talk to each other, and we’re at risk every time we go to the [operating room],’” Tina Foster, a professor of obstetrics and gynecology and community and family medicine at the Geisel School of Medicine at Dartmouth, who was not involved in the study, said. “This is just an example of how there’s an opportunity for improvement in the way that we communicate.”

Sutkin gave an example from the video recordings of a resident performing surgery who was cutting too close to the bladder. The attending surgeon saw it and said “that’s awfully close to the bladder.”

“It would be much better if the attending would have said, ‘Stop, your scissors are pointed towards the bladder. If you continue on, you’re about to cut the bladder,’” Sutkin said.

While studies of miscommunication among medical professionals have been conducted before, Sutkin said this study was the first to look specifically at surgeons.

“We know that miscommunication is the number one cause of error in the operating room, but it’s been studied among inner professional team members like surgeons and nurses,” he said. “No one before has really ever studied the language that two surgeons use when they talk to each other, and especially examine that at a semantics level.”

To reduce ambiguities and ensure they don’t lead to medical errors, the researchers suggested more standardized language in the operating room. For example, operating rooms could have colored signs on the wall so that surgeons could say “move a little blue” rather than “move a little left,” which depends on the surgeon’s point of view.

Standardized language is what the airline industry has done to reduce miscommunications and it was how Sutkin became interested in the topic. He heard about Indonesia AirAsia Flight 8501, which crashed in part due to the co-pilot misinterpreting what the pilot meant by “pull down.”

“I read that story and I’m like, ‘You know, we are so dangerous in the operating room, we could totally do that,’” he said.

The research team’s future work will have attending surgeons and residents separately watch recordings of their surgeries, where the attending surgeon used ambiguous language and compare their interpretations.

“We want to see how much of that work can we take out because the people involved are busy doing something,” McKenzie said.

The results of such studies could help surgeons notice where they were misinterpreted and use more precise language in the future.

“There’s a little bit of mental energy that goes into trying to wonder what you’re actually being asked to do, and if you had that mental energy better able to focus on the task itself, that would be great,” Foster said.

While such studies will happen in the operating room, there are still lessons that can be applied in daily life, according to McKenzie.

“I think it’s important for people to be mindful of how much work they make their listeners do with ordinary language. We do a lot of work when we’re listening,” he said.

This story was originally published September 18, 2021 at 4:07 AM.