As a student, you may recall being taught how to differentiate medial from lateral, superior from posterior – but did we ever consider distinguishing right from left?

Perhaps not. And yet this spatial orientation is crucial in many aspects of healthcare, both in terms of making a laterality-based diagnosis or targeting a lateral-based intervention.

From performing surgery on a limb to administering a lateral nerve block, ordering a limb joint X-ray or performing a pleural aspiration, laterality decisions are commonplace in healthcare.

For many, this is an intuitive and unconscious task, taken for granted and considered second nature. But for some, discriminating right from left can be a challenge that requires conscious effort.

"My left or your left?"

Distinguishing right from left calls upon many higher functions, including our ability to process sensory information and language, visuospatial orientation and memory recall.

More than this, in healthcare, we often present ourselves facing patients. In this spatial orientation, the practitioner's left side is opposite the patient's right side - that is, extra-egocentric orientation. In such situations, we also draw upon mental rotation to discriminate right from left.

Not everyone has the same spatial orientation capabilities in distinguishing right from left. In one study, 14.6% of the general population reported challenges in discriminating right from left. Objectively, greater than 50% of medical students scored less than 77% in a left-right psychometric discrimination test.

So what are the conscious efforts of those who are challenged in making left-right decisions? In a qualitative study, we shed light on the fascinating steps that such individuals take, and medical students described the process of how they discriminated right from left.

Initially, many used a technique for making such decisions - for example, holding their thumbs and index fingers at right angles, with the side that looks like an 'L' indicating their left side. Others deploy verbal labels or artefacts, like saying, "The hand they write with is their right," or noting the hand that their wedding band is on indicates their left side.

In a clinical context, distinguishing right from left in a patient presents these individuals with additional levels of complexity. After distinguishing right from left in themselves, they had to mentally project their right or left side onto the patient and then mentally navigate the rotation, sometimes moving their body to mirror the patient's orientation.

Importantly, many of these individuals have adapted to this process and include double-checks to safety net their decision-making. However, many felt embarrassed and made attempts to conceal their challenges from others.

The wrong side in healthcare

Taking the wrong turn on a journey may be trivial in our personal life, but laterality errors in healthcare have the potential to impact patient care and outcomes. At worst, they can contribute to a catastrophic error, causing patient harm and impacting the healthcare professionals involved.

Despite being classed as 'never events', laterality errors still occur in healthcare. Regardless of abilities to discriminate right from left, all practitioners are at risk of making a laterality error. As the saying goes, "To err is human."

Much has been done to reduce the potential of laterality errors in healthcare at the individual, team, and organisational levels of patient safety. Some examples of things that have made a positive impact in reducing left-right errors include pre-operative and procedural checklists, involving patients in decision-making, and technological tools.

At a fundamental level, it is important to emphasise awareness that we are all at risk of making a laterality error. We all need to take time and mindfully ensure the correct side is selected, ideally with minimal distraction.

More than this, we need to realise - and destigmatise - that some individuals require additional conscious effort in making left-right decisions. Having a culture of openness and empowering individuals to speak up, question and double-check our lateral decisions is vital in safe clinical practice and collective team competency.

Being receptive to others, including patients, querying us if we have potentially selected an incorrect side is essential for safe clinical practice. And perhaps there is room to revisit foundational training and further emphasise the importance of left-right discrimination as we teach students about anatomical orientation.

While it is a critical task in disciplines such as surgery, left-right errors can occur in all aspects of healthcare, and left-right decisions know no borders.

The views expressed in this article are those of the author and do not necessarily reflect those of the MDU.