Say What You Mean: Imprecise Language Can Lead to Medical Errors
October 1, 2022 3 minutes read
EXECUTIVE SUMMARY
Imprecise language during surgery can threaten patient safety. Research indicates comments and instructions during surgery often are subject to misunderstanding.
- A surgeon may think an instruction is clear but other team members may have to use context clues and hope to understand.
- Most surgeons are eager to be more precise when alerted to ambiguity.
- Efforts to speak politely may inadvertently lead to confusion.
Patient safety can be threatened by the use of imprecise language in the operating room. Research suggests ambiguous instructions are surprisingly common. The surgical team members often do not realize comments are unclear and automatically use context clues to fill in the gaps.
Fortunately, the ambiguous comments usually are sorted out before the patient is harmed, but there is a risk of serious error, says Andrew McKenzie, PhD, associate professor of linguistics and affiliate professor in indigenous studies at the University of Kansas.
“We find that when surgeons are talking in the operating room, their language is not as precise as the surgery they are performing. There ends up being a lot of potential ambiguities that need to be corrected or repeated, or may be misunderstood,” McKenzie explains. “A lot of those can lead to an error, a near miss, or potentially a delay. We suggest that people be aware of how their speech can be unclear even if it does not seem like that to them.”
McKenzie’s recent research addressed the risk to patient safety from imprecise language. McKenzie and colleagues reviewed video recordings of six surgical procedures performed by residents under the supervision of specialist physicians. The review revealed 31 instances of inexact language that could have led to a medical error.1
McKenzie is a semanticist. In the paper, McKenzie and colleagues described 14 categories of inexact language that could lead to a medical error. The authors defined deixis as “linguistic expression that explicitly refers to the utterance it was made in, the locations of the people participating in it, or the immediate context surrounding it.” An example is, “Take this over there.” In that instruction, “this” and “there” are potentially unclear, he explains.
McKenzie also cites an unclear anaphor, which is a phrase “for which antecedent is not clearly stated or multiple possible antecedents exist.” He offers this example: “Bill went home. Ted came home later. He went right to sleep.” In that statement, it is not clear who went to sleep.
Those ambiguities occur in surgery in addition to questions or suggestions that should be phrased as explicit instructions.
“We identified a large number of potentially ambiguous words and phrases used by surgeons in the OR,” McKenzie and colleagues wrote. “The lack of patient injury suggests that much of the vague language was successfully interpreted by the subjects; however, we suspect there was still a large amount of ambiguous language that was unsuccessfully interpreted, or at the least required extra time and mental energy to interpret it.”
Surgeons Open to Improvement
Often, surgeons are unaware they are using imprecise language, McKenzie says. Once the issue is pointed out to them, surgeons usually are enthusiastic about learning to become more precise when speaking during procedures.
“The rates and incidence of unclear language in surgery are not that much different from what we find in ordinary conversation,” McKenzie notes. “We do a lot of work as listeners to fill in the gaps with shared knowledge, our previous experience with that person and others, and in the case of surgery, just knowing what the surgery is.”
Gestures also can help clarify meaning, as when a surgeon says, “Cut here,” and gestures to the right spot. Although these context clues may help the other person understand, reliance on such measures can increase the risk of patient injury, McKenzie explains. For instance, surgeons sometimes report their imprecise language to a resident was the result of trying to be polite rather than issue explicit, direct instructions. That is common in everyday conversation as well because people can perceive explicit language to be aggressive or condescending.
“Unless things get tense, the surgeons might not say very directly, ‘Bring the retractor and place it at this exact spot.’ They will just say, ‘Retractor,’” McKenzie explains. “In surgery, we sometimes have to remember that trying to be polite can lead to misunderstandings and increase risk.”
REFERENCE
- Liu C, McKenzie A, Sutkin G. Semantically ambiguous language in the teaching operating room. J Surg Educ 2021;78:1938-1947.
SOURCE
- Andrew McKenzie, PhD, Associate Professor of Linguistics, Affiliate Professor in Indigenous Studies, University of Kansas, Lawrence, KS. Email: [email protected].
Imprecise language during surgery can threaten patient safety. Research indicates comments and instructions during surgery often are subject to misunderstanding.
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