Watch the Volume!

volume dialWho would you say has done the most in recent years to improve the atmosphere in operating rooms around the country?

Many of today’s surgeons would likely agree that the credit should go to Steve Jobs. As strange as this choice might sound, the introduction of the iPod simplified the life of the operating surgeon by eliminating the need to carry boom boxes, cassette tapes, and stacks of CDs. The “shuffle” feature also got rid of the endless media looping that caused many a surgeon to cry out mid-procedure, “Will someone please put on a new CD, already?!?”

While controversy does exist about the presence of music in the operating theater, it’s a safe bet that most surgeons who were trained in the years following the vinyl period would say that the right music is actually an integral part of the operative experience for the surgeon, the staff, and even the occasional patient who happens to be awake at the time. The music keeps the operative action rolling, provides a calming atmosphere (unless the surgeon happens to be a metal head), and helps reduce everyone’s stress levels.

The key, however, is to respect the fact that too much noise in the OR can be a source of distraction, missed orders, confused messages, and increased risk for the patient. While we could debate whether the specific type of music is to blame, when it comes down to it, choosing the music is the surgeon’s prerogative. The volume, however, needs to be adjusted for the setting, and rave-like volumes are never a good choice.

When bad things happen in the operative theater and folks—including plaintiff attorneys—are looking for the root cause, you can bet that anyone in the OR is fair game for an interview or deposition. We all have our habits, but if yours is to blare music at a volume that causes your staff to label you as a “blaster,” this information is likely to come out in the after-action review following an incident of patient harm. You, as the surgeon, will be directly in the cross hairs.

Imagine trying to explain to a jury why you do not believe your loud music contributed to the adverse outcome when your staff have been heard to remark, “It’s so loud in that room that I can’t hear what’s going on.” You (or your insurance company representative) will likely be pulling out the checkbook on that one.

If you are in the (likely) majority who relish the idea of a full day of surgery with just the right playlist, be aware that you are not just the leader of the band—you’re also the captain of the ship. Keep the environment safe for your patient, and don’t give the plaintiff attorneys the opportunity to drop the hammer. Feel free to enjoy your music, but play your selections at a volume that complements your skills and doesn’t detract from your efforts to get the optimal outcome for your patients.

Finally, as a bit of a postscript, it is also a good idea to edit your playlist to avoid embarrassment or offense. The Ramones’ “I Wanna Be Sedated” and Pink Floyd’s “Comfortably Numb” are great (if somewhat tongue-in-cheek) selections when a deep sleep is called for. But “The Smell of Death” by Lynyrd Skynyrd and “Don’t Fear the Reaper” by Blue Öyster Cult are probably not the tunes that your patient wants to hear when arising from the fog of a good general anesthetic.

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