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Surgeon Fatigue
Surgeons in training - be aware of context switching, attention residue and decision fatigue.
Below is a near miss of mine I don't want you to repeat.
#neurosurgery #training
Below is a near miss of mine I don't want you to repeat.
#neurosurgery #training
I was performing an out of hours emergency operation when a referral came. The referring doctor was adamant that they wanted to speak to me.
I was at the stage of training where I would stop operating to take referrals.
I no longer do this.
I was at the stage of training where I would stop operating to take referrals.
I no longer do this.
I took a brief history, reviewed the scan and said there was nothing to do.
After finishing the operation I sat down to look at the patient's electronic notes and review the scan again.
After finishing the operation I sat down to look at the patient's electronic notes and review the scan again.
I had given advice base on an old scan and the patient required urgent surgery.
They were promptly flown in and had an uncomplicated operation.
Why did this happen?
There are 4 reasons.
They were promptly flown in and had an uncomplicated operation.
Why did this happen?
There are 4 reasons.
1. Context Switching
Context switching is our tendency to switch from task to another.
This is an essential ability for day to day functioning, but comes with a cost.
Context switching is our tendency to switch from task to another.
This is an essential ability for day to day functioning, but comes with a cost.
2. Attention Residue
Attention residue is the penalty you pay for switching tasks.
The new task doesnβt get your full attention because youβre still partially focussed on the previous piece of work.
When taking the referral I'm thinking about the operation and vice versa.
Attention residue is the penalty you pay for switching tasks.
The new task doesnβt get your full attention because youβre still partially focussed on the previous piece of work.
When taking the referral I'm thinking about the operation and vice versa.
3. Decision Fatigue
If you have been making decisions for a prolonged period of time without a break, like taking emergency referrals and operating, the quality of your decision making becomes worse with the passage of time.
This is known as decision fatigue.
If you have been making decisions for a prolonged period of time without a break, like taking emergency referrals and operating, the quality of your decision making becomes worse with the passage of time.
This is known as decision fatigue.
4. Systems Error
The imaging system I use has the flaw that it will not automatically load the most recent scan.
Because of the context switching and decision fatigue I didnβt notice I was looking at an old scan.
The imaging system I use has the flaw that it will not automatically load the most recent scan.
Because of the context switching and decision fatigue I didnβt notice I was looking at an old scan.
Here is a simple system I developed to stop this happening again:
Question from theatre team to referring doc - "Is this a life or limb-threatening referral?"
Yes-->Call on call consultant
No-->Please call back later
Don't know-->Speak to senior and follow above
Question from theatre team to referring doc - "Is this a life or limb-threatening referral?"
Yes-->Call on call consultant
No-->Please call back later
Don't know-->Speak to senior and follow above
There is nothing more important than focussing on the patient on the table.
With the above system that focus is never broken.
With the above system that focus is never broken.
I hope you find this useful and you can learn from my mistakes.
If you enjoyed this thread:
1. Follow me @adi_kumar1 for more of these
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If you enjoyed this thread:
1. Follow me @adi_kumar1 for more of these
2. RT the tweet below to share this thread with your audience
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