Perception May Be Problem Separate From Vigilance

Bryan Bohman, MD

Regarding the article “Reading in the OR” in the Fall 2004 issue, have the authors considered that, under appropriate circumstances, reading might actually improve vigilance in the OR? In my opinion, and in my experience, reading can actually function as a means to keep one’s mind alert during periods of mental hypo-activity.

Eschewing outside stimuli, such as music, conversation, reading, and so on, may seem at first glance to be the most rigorous and admirable way to maintain vigilance, but is that really the case? We all know that there are periods during the anesthesiologist’s day when his or her mental capacity is not being fully utilized. The mind will occupy itself one way or the other: I would submit that daydreaming might be a greater hazard than other activities that actually encourage a more alert mental status.

Of course, it is incumbent on the practitioner who chooses to read, converse, check e-mail, or whatever in the OR to honestly assess his own level of vigilance during these activities. Perhaps one physician will find himself too distracted by certain kinds of music, another by a specific kind of reading (novels, for example), or another by engaging in political debate in the OR, while another will find that he loses track of time and lessens his vigilance if he does not engage in some additional mental activity while providing anesthesia care.

In each case, we must currently rely on the practitioner’s self-assessment. Perhaps, rather than condemning certain activities out of hand, a better approach might be to devise a method for individual physicians to better assess their own mental capacity for vigilance during a variety of activities and in a variety of situations. I think this would be quite difficult, but it’s worth considering.
The public relations aspect is a completely separate issue, in my opinion, and admittedly a significant one. But is it helpful when observers who “feel” that patient safety is compromised by reading in the OR publicly condemn the practice despite any evidence in support of their view? It’s interesting that those who denounce OR reading are often engaged in the academic practice of anesthesia. Although they certainly have as much right to their opinion as anyone, in the absence of data I would give more credence to the intuition of those who have years of experience, day in and day out, providing safe, solo, hands-on anesthesia care to their patients.

Bryan Bohman, MD
Palo Alto, CA