The Physician as Eavesdropper: Interdisciplinary Communication in the Operating Room

As the Royal College gears up for the release of the 2015 update to the CanMEDS roles, I have been thinking about a competency that we rely on far too often—the physician as eavesdropper. Anaesthetists are our unsung heroes, but our colleagues on the other side of the sterile drape have learned to glean, assume, suspect, infer, and guess at what’s going on during the surgery from sounds and muttered phrases coming from our side. As a simulation educator who is fortunate enough to have facilitated and debriefed numerous scenarios each year over the last decade, I have probably learned more about interprofessional and interdisciplinary communication than any of my students. I preach that in medicine, and in fact in most facets of life, “communication fixes everything.” We teach our residents to hand over information during a crisis with military efficiency. We teach them to use closed-loop communication when issuing orders to allied health personnel. We teach them to verbalize their plans so that everyone in the room is on the same page. But when we become stressed in the operating room, we know that the anaesthetists with whom we are most comfortable working are the ones who can seemingly read our mind. They have mastered the art of listening to the suction in order to gauge blood loss. They have learned to ask for carbetocin when they hear us talk about the boggy uterus. They call the blood bank when we wonder aloud who the “second on-call” is. They are good at bailing us out, but I think they deserve better.

The last few years have seen a flurry of attention paid to improved patient safety through interprofessional and interdisciplinary team training. The surgical checklist and preoperative pause are examples of interventions aimed at improving patient safety. However, I think the more important potential outcome of these interventions is an improved culture in the operating room, in which the surgery begins only once everyone in the room has the same perspective on what’s about to transpire. Irrespective of the recent high-profile publication that called the utility of the checklist into question, anything that chips away at the hierarchy in the operating room and improves sharing of information is a step in the right direction. I would like to see this explicit sharing of information continue throughout the operation, and as we surgeons become better masters of “communicator” and “collaborator” competencies, the anaesthetists can let their eavesdropping skills wane. We know that superlative communication skills are appreciated by patients and can sometimes moderate malpractice claims. My anaesthetist friends tell me that they also appreciate a communicative surgeon with good insight who stays out of trouble. Let’s endeavour to be the kind of surgeons that anaesthetists want to work with; better communication may not fix everything, but it never hurts.