Who is distracting whom?

I congratulate Jenkins et al. on their well-conducted study of noise and conversations during anaesthesia for caesarean section 1. In conjuction with their 2 and other groups’ 3, 4 previous work, it is becoming increasingly, if unsurprisingly, apparent that operating theatres are noisy, distracting places in which to work. This may have both negative and positive effects 5-7. I would strongly support the authors’ contention that not all distractions can be avoided and that prioritisation of actions, coupled with better communication within the team, are part of the solution. However, our work 3 suggests that anaesthetists themselves are the culprits a fair proportion of the time. Not only does this cause distraction at the time, but it also reinforces the culture that certain key phases of anaesthesia, such as drug preparation and emergence are acceptable times for distracting conversation. Edicts and exhortations from associations and colleges may help, but ultimately every anaesthetist can help change this culture through his/her own individual behaviours. How long would it take to change drug preparation culture if every anaesthetist in a department, politely but firmly, made clear that he/she is not going to discuss any non-emergency matters during that time? Jenkins and colleagues are helping to provide an evidence base for the pathophysiology of the anaesthetic process. I look forward to the next phase of research into interventions that make a beneficial impact.