Study Examines Doctor s Inattentiveness During Surgery

A recent study in Academic Medicine, titled "Slowing Down to Stay Out of Trouble in the Operating Room: Remaining Attentive in Automaticity" examined behaviors that contribute to inattentiveness in the operating room and, ultimately, contribute to instances of malpractice.

As surgeons gain experience, they develop the ability to work in a more automated way. The study examines "automaticity" or the "ability to think in a predominantly intuitive manner," as it is defined in the report. This way of thinking, however, is not something that doctors can do consistently. Often, situations arise during surgery that are not routine and doctors need to recognize the need break the automatic cycle.

The focus of the research reviewed the different ways surgeons make the transition from the automatic mode to a more focused effort. This phenomenon was referred to by the authors as "slowing down." This is not a term defining the physical speed at which surgeons work, but rather the changes in focus and attention. The study determined four different types of slowing down behaviors.


"Stopping" was the most intrusive manner of slowing down. It refers to situations when the surgeons actually stopped the procedure to assess the situation or gather more information. The doctors often referred to this step as an opportunity to "regroup" or "reassess" their approach.

Some of these moments were proactively planned, often when surgeons knew they should expect to encounter difficult circumstances. Planning stopping moments allowed not only the surgeons, but the assisting doctors and staff to prepare for the next step in the procedure and gather additional resources if necessary.

Whether the event was planned or unplanned, stopping was an effective strategy to provide the surgeons with "more cognitive space" to gather new information.

Removing Distractions

This method involved the surgeon actively directing others to remove or stop distracting events in the operating room. The report details situations in which surgeons were talking about families, sports and even listening to music in some cases. When the situation dictated, the surgeon would take steps to remove the distractions in an effort to regain focus on the procedure during critical events.

Focusing More Intently

During this type of slowing down, the surgeon allowed the distractions to continue, but focused more attentively on the situation. Though not participating in the distracting events, the surgeon would "withdraw from extraneous" conversations or activities.

Fine Tuning

Fine tuning involves "momentary increases in attention or focus" that happen numerous times during the procedure. Doctors were able to continue teaching, listening to music or discussing other activities without others, including the researchers, noticing the transition.

Drifting: Failing to Correct Behaviors

The study also noted the phenomenon of "drifting" or the state in which doctors fail to recognize the need to move from the automated state to one of more focused effort. Surgeons cite complacency as the main cause of drifting, due to the more routine or "boring" parts of the procedure. This is a time during the procedure when the potential for mistakes greatly increases.

Consulting an Attorney

Unfortunately, surgical errors and other incidents of malpractice will continue to happen despite moments of careful concentration. If you or a family member has been injured during surgery or another act of medical malpractice, it is important to contact an experienced attorney as soon as possible.