Surgons are people, and people are animals, and animals often fight. Which is why Frans de Waal, an expert on animal behaviour, has turned his attention to the operating theatre to see if the methods he honed studying chimpanzees might be used to improve surgical practice.
Dr de Waal—and, more particularly Laura Jones, his colleague at Emory University in Atlanta, Georgia, who did the actual field work—used those methods to construct ethograms of surgical teams. An ethogram is a list of all the types of behaviour that occur within a group of animals. To draw up these lists Dr Jones observed interactions between 400 doctors, nurses and technicians during 200 operations. She logged all the non-technical communications she spotted, and classified them as “co-operative” (likely to lead to better surgical outcomes), “conflictive” (potentially jeopardising patient safety) or neutral.
As she describes in the Proceedings of the National Academy of Sciences, after analysing each of more than 6,000 exchanged insults and pleasantries, she found that surgical communication does indeed mimic wild-animal behaviour, both collaborative and hostile. In particular, as happens among wild animals, individuals jostle for dominance with others of their own sex while trying to ingratiate themselves with members of the opposite one.
Given males’ especial reputations for such jostling, it was hardly surprising that predominantly male surgical teams that were led by a man proved twice as likely as similar teams led by a woman to experience conflict (50.6 % of operations, rather than 21.3%), whereas in female teams there was no difference, regardless of leader. More intriguing though, was that when Dr Jones looked at the fraction of interactions which were collaborative, it was higher, regardless of whether the lead surgeon was a man or a woman, when that leader was of the opposite sex to most of the underlings.
Previous research suggests that between 70% and 80% of surgical mishaps are caused by interactions between those present going wrong. This work by Dr Jones and Dr de Waal suggests how that fraction might be reduced both in the short term, by mixing and matching personnel, and in the long term by encouraging more women into what is now a male-dominated profession, so that such mixing and matching is easier to do.
