Abstract
Introduction: Among the pantheon of medical errors, wrong site surgery (WSS) is thankfully rare. However, the results can be devastating particularly if amputation is the proposed surgery. WSS can occur due to simple mistakes in communication between patient and surgeon. This project looks at one particular cause of such miscommunication: toe identification.
Method: 100 consecutive patients were asked to label their toes. The first 50 were asked to label their left foot, the subsequent 50 their right. Patients were not asked to number or name their toes as it was felt that this could bias their answers. Instead the patients were asked to imagine a hypothetical situation in which they had pain in their toes. They were asked to explain which toe was painful, as if over the phone so that they were unable to point and thus had to label their toes. No prompting was given.
Results: Disagreement between patient and professional terminology was stark. Overall, 3% of patients incorrectly labelled the little toe and a staggering 26% mislabelled the ring toe. 10% gave a contrary label to the middle toe while 17% mislabelled the index toe. The great toe caused least problems with only 2% of patients incorrectly labelling it. Patients who numbered their toes were much more likely to mislabel them than those who named them.
Conclusions: There is a huge discrepancy between the terms used by doctors and patients to label toes, increasing the chances of miscommunication and WSS. This study highlights the need for unified terminology amongst the orthopaedic profession. We suggest using the terms great, index, middle, ring and little toes. Numbering the toes should be avoided, as numbers are used in wildly contradictory ways by doctors and patients.
Correspondence should be addressed to A.H.N. Robinson, BOX 37, Department of Orthopaedics, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Trust, Hills Road, Cambridge. CB2 0QQ, England.
