The WHO Surgical Safety Checklist was introduced to reduce errors and improve communication. A noble goal. In practice, it has become a speed-reading competition in which we all pretend to listen while thinking about lunch.

This morning’s briefing went something like this:

Me: “Right, shall we do the brief?”

Surgeon: already scrubbing “Yes, yes. Mr Smith, seventy-two, right hip, no allergies, nothing interesting.”

Me: “Actually, he’s got—”

Surgeon: “Standard anaesthetic, shouldn’t take more than an hour.”

Me: “He’s got severe aortic stenosis.”

Surgeon: pause “Does he?”

Me: “Yes. And he’s on warfarin. And he had an MI three months ago.”

Surgeon: “Oh. Right. That’s… that’s probably relevant.”

The art of selective hearing

I’ve noticed surgeons have a remarkable ability to hear only certain frequencies. They can pick up the words “quick,” “straightforward,” and “shouldn’t be a problem” from across a crowded theatre. But words like “complicated,” “co-morbidities,” and “perhaps we should discuss this” seem to operate at a frequency below their auditory threshold.

The solution, I’ve found, is volume. Not literally shouting—that would be unprofessional—but speaking with the kind of emphasis that makes it clear you’re not simply making small talk.

“He has SEVERE AORTIC STENOSIS” tends to get attention.

What the checklist actually achieves

In fairness, the checklist has probably prevented disasters. Somewhere, a wrong-site surgery didn’t happen because someone ticked a box. That’s genuinely good.

But I can’t help feeling we’ve mistaken the form for the function. The checklist is meant to prompt communication. Instead, it’s become the communication—a ritual we perform to demonstrate we’ve communicated, regardless of whether any actual information was exchanged.

Still, at least we have documentation proving we briefed. Even if the brief was three words and a shrug.

Tomorrow’s list looks straightforward. Which means it won’t be.