On situational awareness and veterinary oncology…

Situational awareness is “the perception of environmental elements and events with respect to time or space, the comprehension of their meaning, and the projection of their status after some variable has changed, such as time, or some other variable, such as a predetermined event.” In other words, were talking about paying deep attention to what’s going on around you.

I have an intense fear of flying. It’s called aviophobia if we’re being technical. I also possess an unnerving obsession with plane crashes. My favorite television show is “Air Disasters”, on the Smithsonian channel. I know it’s weird. But I can’t stop myself from watching.

Each episode of Air Disasters recreates the events surrounding a particular accident, most often using elaborate sets and actors portraying key figures, alongside interviews of the actual people involved in the crashes. The show is in its ninth season, in case you’re wondering if there were enough stories to sustain it over time… A direct description from the shows website:

“Harrowing stories of tragedy and triumph are brought to life through official reports, transcripts and interviews with the pilots, air traffic controllers, and survivors of history’s most terrifying crashes. Widely considered to be the safest form of travel, air transportation is still in its infancy and when midair calamity strikes, the results are often catastrophic. From the cockpit to the cabin, from the control room to the crash scene, we uncover what went wrong, then reveal what’s being done to ensure these atrocities never happen again.”

One of the common themes of each episode is the cause of an air traffic accident is always of a multifactorial nature. Even when the reason for a crash seems obvious; bad weather, pilot error, mechanical failure, etc., that one mistake or problem isn’t the only cause of disaster. And a frequent contributing factor is a lack of situational awareness on the part of the flight crew.

As an example, Flight 173 from JFK to Portland crashed on December 28, 1978. The entire flight was routine and smooth. On approach to Portland, while lowering the landing gear, the flight crew heard and audible “thump” along with an abnormal yaw of the plane. The indicator light showing the landing gear was properly locked in position also failed to illuminate. The crew requested to circle the airport at a low speed and altitude while they sorted out if these was a problem. After circling for over an hour, upon final approach to land, both engines flamed out from lack of fuel, and the plane crashed about 6 miles from the runway.

While the decision to abort the landing was judicious, the accident occurred because the flight crew became so absorbed with diagnosing the problem that they failed to monitor their fuel levels. Lack of situational awareness contributed to the crash.

How does this relate to veterinary oncology?
Remarkably well.

The diagnosis and treatment of cancer in pets requires an intense amount of situational awareness.

I have to listen intently to what an owner describes to me regarding their pet’s clinical signs, previous health history, and also their goals for their pet’s quality of life.

I have to examine prior medical records and sort out important details from extraneous data.

I have to perform a thorough physical exam to ensure the animal is in good enough health to undergo the recommended diagnostic tests and treatments.

I have to decipher lab tests and biopsy reports with precision.

I have to calculate dosages of medications that have the potential to cause severe side effects or even death with a marginal error in their administration.

I have to instruct owners about signs to look for indicated complications related to treatments or their pet’s disease process. The list is endless.

Decreased situational awareness, even if only marginal, in any one of those areas, can lead to mistakes that, at best, could cause a patient to become ill, and at worst, could cause their death.

It’s happened to me before. I’ve made mistakes. Fortunately, not to the extreme of causing significant morbidity.

I’ve forgotten to verify the dates and names on lab work I’m reviewing, deeming it adequate for treatment when, in truth, I lacked the correct information.

I’ve failed to listen to details owners provided about how their pet did after their previous chemotherapy treatment and wound up forgetting to prescribe medication to lessen effects.

I recall intently examining the sequence of images on a CT of a tumor as the dog passed through the scanner, not realizing the pet was actually beginning to wake up from anesthesia before completion.

On the grand scheme of errors, I’m fortunate these are relatively benign instances of me lacking situational awareness. It’s tough to admit to being distracted or losing focus. Like many of my colleagues, I’m a perfectionist. And I’m also hard on myself when it comes to making mistakes.

Those characteristics can be used to my advantage – they make me a better veterinarian and force me to set high standards to the level of medicine I put forth. They can also haunt my success – paralyzing my ability to make timely choices and lead me to over think a case to the point of confusion.

I’ve taken to practicing being fully situationally aware as often as possible. To be honest, it’s a bit exhausting. But given the magnitude of the responsibility of my job, I have an obligation to do so.

I’d expect the same from any professional individual.

Especially a pilot.