Before you read the rest of this blog, click here and take a look at the radiograph. Did you notice anything . . . odd? If not, you’re in good company. The image shown was used in a study with trained radiologists. A vast majority – 83% – did not notice the gorilla in the upper right hand corner of the lung.
Yep, that’s right. There’s a gorilla in that scan. Did you miss it too?
This study was based off a study performed in 1999 that drew attention to the “inattentional blindness” effect. Essentially, it means if you’re busy doing something that requires a lot of concentration, there’s a lot you can miss. This new study attempted to determine whether people who were “trained for looking” – i.e. radiologists – would be better at noticing something “off”. Actually, they were worse, based on the percent of people who missed the gorilla in the original study – 50% – being far less than the percent of radiologists – 83% – that missed the gorilla in the radiograph. What’s particularly disturbing is that what the radiologists were looking at was a radiograph, something they’ve been specifically trained to evaluate. To be fair, they were specifically asked to look for cancerous nodules . . . not large, hairy animals.
What are the broader implications of this study? Well, the first is acknowledgement of the possibility of missing the seemingly obvious. This is not, of course, limited to radiologists. Examples of this happening are seen all over healthcare – when alarms are assumed to be malfunctioning, rather than actually indicating an issue that needs to be dealt with. Or when sponges are left inside a patient. It’s certainly not because the surgical staff isn’t concentrating. Or when you have a patient seemingly ready for surgery . . . only it’s not for him. When you have a patient who’s ready to go, and a staff who’s ready to go, it is only to easy to assume that – because everything LOOKS right, it is.
The next question, of course, is what can be done to deal with “inattentional blindness”, now that we know it exists for anyone, regardless of specialized training? Strategies that have been developed to deal with all kinds of medical errors can also help with inattentional blindness. Taking time to catch your breath, then going back to look again – such as occurs when using a time-out prior to surgery – can give you a fresh look that is more likely to catch those gorillas. It can also help to use more sets of eyes, by bringing in different staff members from different areas of expertise. Checklists can also help to focus on the obvious – forcing a check on a patient’s identity, for example.
Much like in the gorilla studies – where people overestimated their ability to notice outlying events – medical personnel who have effectively incorporated time-outs and/or checklists have been surprised at the number of potential events that have been caught by these aids. Obviously, they’re not a panacea, or a replacement for a well-trained, caring staff. So, the next time something seems “off”, take another look. Maybe it’s a gorilla.