The other day I was in surgery, working away with one of my residents, when all of a sudden, I could feel the vibration of my cell phone on my hip. Normally, if I’m doing the work myself, I don’t notice the call, but this time I wasn’t doing the majority of the work, so my mind was more receptive to the sensation. My phone’s annoying motions didn’t pull my attention full from my work, but I immediately became aware of the rest of the room around me: the beeping of the pulse monitor, the circulating nurse chatting in the background, etc.

Life is full of distractions. It’s often scary to see just how distracted people can be, especially driving home each night. I see people daily reading their cell phones instead of paying attention to the road. I’ve witnessed women putting on make-up and even once, a guy reading a newspaper while moving! I was once rear-ended by a taxi driver who was driving distracted.

Some very recent research published this past October 2017 by evolutionary biologists lends some interesting perspective on this issue.² As I’m sure you’re well aware, humans have an enlarged brain that allows us to do things of which no other animal species is capable (notwithstanding some stupid human tricks available on YouTube videos). However, the larger brain also requires significantly greater energy, which has lead scientists to a “selfish brain” hypothesis. This idea states that the brain will prioritize its own metabolic needs over those of other organs.

To test this idea, researchers from the University of Cambridge examined 62 male student rowers. They had them perform a mental recall test while at rest and then had the same rowers again perform the same recall test, but this time, while simultaneously performing indoor rowing. They found that both mental output and rowing power dropped while doing the simultaneous activities, with the physical aspect declining more than the mental power. The study’s authors stated this supported the theory that the brain prioritized cognitive function.² 

Though highly preliminary, this work definitely fits in with both personal experience and the research on distractions in medicine and society. Take, for example, the fact that automobile driving quality is significantly reduced in drivers who are distracted.^3,4 This is so significant that distracted driving may be as bad or worse than alcohol intoxicated driving.^5,6

As with driving, operating room distractions can be detrimental. Wheelock and colleagues observed 90 general surgery cases using validated observation tools. They found major distractions were caused by people external to the operating staff and “case-irrelevant conversations.” They found decreases in team performance as well as increased stress on nurses, surgeons, and anesthesiologists¹ due to these distractions.

---

“Distraction more adversely affects junior residents than it does more senior residents”

---

Interestingly, distractions are even more significant for our trainees. During an observational study of 11 physicians in an intensive care unit, researchers found resident physicians to be particularly susceptible to distractions and were more likely to fully abandon their prior work in favor of new distractions.⁷ Similarly, during a simulated arthro-scopic knee surgery, junior orthopedic residents were more likely to be affected by distractions than were more senior residents.⁸ A systematic review of 17 observational studies lends further evidence to the significance of distractions on surgeon performance in the operating room. One of the repeated themes throughout this study was that distraction limited the acquisition of automaticity in resident surgeons, an important aspect of developing expertise in surgeons.⁹ 

---

“Distraction limited the acquisition of automaticity in resident surgeons, an important aspect of developing expertise in surgeons”

---

I’ve seen this in action while training resident podiatric surgeons. If I ask a resident (especially a first year) a question while they are actively doing a procedure, I will see an all-too-common response: head moves up to look at me, eyes go unfocused, dominant hand moves slightly downward, and the procedure stops. It’s classic. Because of this, I generally ask very few probing questions of the resident during the procedure. I let them focus on the task and ask questions only to keep the procedure moving safely and efficiently. Although I enjoy listening to music in the operating room I’m strongly considering making it a policy to limit that distraction, at least for my younger trainees.

---

“Although I enjoy listening to music in the operating room, I’m strongly considering making it a policy to limit that distraction, at least for my younger trainees”

---

Clearly human performances suffer when multitasking. We are serial processors, rather than parallel, in more ways than we’d like to admit. The jury, it seems, is in. We function much better when we are not distracted, despite the oh-so-many distractions that pull at each of our attentions. Here are a few suggestions to help mitigate the damage of distractions.

Distractions galore in a busy life, but with a little forethought we do not have to be slaves to our biology – oh my daughter just called…what was I saying? Someone just texted me. What was I doing?

Darn, a good TV show just started. Where was I?

What was that sound?

Who’s calling now?

That looks likes a good movie….