Interruption

I haven’t been in a cockpit since I was 12 years old – then, somewhere over Europe, I was allowed to chat with an El Al pilot and crew. Today, this would be considered an outrageous breech of regulations, and, justifiably so.

I cannot therefore comment on what happens at 45,000 feet. I imagine a calm, controlled, relaxed and ideally up-beat scene. Like anaesthetists, pilots prepare for the worst but mostly enjoy an untrammelled existence.

We are told that humans can only process a relatively small, finite amount of information at once. Nowadays we describe this as bandwidth, an allusion to the limitations of the internet.

I can only do one thing at a time, anything more and my abilities deteriorate – the quality of my performance falls away, things slow-down and the tension mounts.

I have had discussions with colleagues who appear to be able to multi-task, with, the most common suggestion being that this is a gender thing; harking back to evolution – men evolved to hunt, women, care for children, cook, mend or whatever.

My kids seem to be able to watch TV and do their homework; something I couldn’t ever achieve. Perhaps they are evolving.

On the ward round there is a difficult balance or interruption, attention and focus.

I must focus on the patient before me; listen to their story, integrate the symptoms and investigations, work-out a plan of treatment or care. At times this can be difficult. Frequently we are pulled in to heuristics; here is an example:

89-year-old man,

fall;

heuristic:

Listen to the story, establish that nothing is broken, there is no sinister cause (clot, heart attack), look for heart murmurs, check mobility, look at blood tests, ECG, X-rays, lying and standing blood pressure and, if all is OK, home.

Simples.

Indeed, inevitably one day they will replace me with a special falls-assessment robot.

What happens however, is, during conversation with old man, I will be questioned about old woman I saw half an hour before, then, a phone call or a text, WhatsApp, fire alarm, request to speak with family… it goes on; handwriting, abbreviations, acronyms, trying to teach, explain and explore, smile, joke, relax, manage time in order to get to meeting, it is sometimes a whirlwind.

I don’t know if we would allow pilots to work like this.

We could create a hunter model. Allow doctor (me) to focus solely on the task in hand and everything else has to stack-up or get in queue. You could argue that interruptions are a hazard in themselves, yet, is interruption, or the ability of doctor, patient, porter, nurse, pharmacist or therapist to speak-out or express themselves not part of the tapestry of our safety culture?

I have seen colleagues who possess such an air that no one would dare interrupt; mitigated language is the norm, questions are left until later.

I’ve never wanted to be like that, yet, it is so very hard to operate in situations of overstimulation.

In the rainforest (where we likely went before or after the savannah), the rain is both a help and a hindrance; you can’t hear prey or the predators. The pitter-patter cancels-out the in-between and things become still.

If there were ward-round, noise cancelling headphones everything would be OK, although I doubt my patients would be impressed with my appearance.

It is a goldilocks phenomenon. Not too much, not too little; just right. Mostly, it will be wrong, and we will have to get along. That is how it is.