Originally published by Rita Handrich.
Back in the early 2000s we began to see pictures of people writing on their non-surgical side in black magic marker (“not this leg!”) to avoid medical mistakes. And I remember wondering how any surgeon could make that sort of error. Well. It comes from right-left confusion and the many distractions prior to surgery. And yes. It is good neither I nor my siblings are surgeons.
Researchers from today’s article talk about distractions like phone calls, bleeping monitors, and questions from patients, their relatives and colleagues all while attempting to begin a surgery. In the midst of all these distractions, the researchers measured the ability of 234 undergraduate medical students in Belfast, Ireland (55% female; 88.8% right-handed; 62.8% were between 18 and 20 years old and the remainder were 21 or older;) to make right-left judgments. Even the background noise of the facility was enough to impair some students’ decisions. When the researchers asked the students questions while also asking them to make right-left decisions, the errors increased and the researchers called it “the distraction effect”.
Here are some of their findings:
Participants were asked to rate their ability to distinguish between right and left and most of them though they were much better at the task than they actually were (as measured later in the experiment).
Females were more prone to distraction (and increased errors) than were males [F(3,211) = 3.53, p < 0.05, partial η2 = 0.05]. This apparently is a commonly found gender difference in right-left discrimination and is not specific to these Belfast medical students.
Older participants were more distractible than younger participants (but let’s remember these are undergraduate pre-med students and almost all quite young).
Cognitive distraction (as compared to the audible distraction of noise in the area) resulted in more errors in discriminating between left and right.
When the only distraction is background noise, it seems to have little impact on the ability to distinguish between right and left.
The researchers suggest constant awareness of the complexity of right-left discrimination and ongoing assessment of the ability to accurately discriminate. This makes sense from an awareness perspective but, in this research, most participants did not think they had any difficulty with right-left discrimination. Thankfully, many medical centers have multiple checks and balances to avoid medical mistakes like removing the wrong kidney, operating on the wrong arm, or even amputating the wrong leg.
From a litigation advocacy perspective, this study shows us that basic distraction can result in errors that, if unchecked, could have disastrous results. This study is about right-left confusion, but it seems obvious the issue applies to other behaviors just as well. It highlights the importance of ongoing self-assessment and self-awareness as well as policy and procedure updates for medical training programs, hospitals, and other facilities where people are being cared for or having surgeries. And in the event you wish to check your own right-left discrimination ability, here’s an online test on which I did very poorly.
McKinley, J, Dempster, M, & Gormley, GJ (2015). ‘Sorry, I meant the patient’s left side’: Impact of distraction on left-right discrimination. Medical Education, 49, 427-435
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