The LASA Risk Hiding in Plain Sight (And Why It Exists in Your World Too)
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"Atropine," I called out, eyes on the monitor. Within seconds, my patient stopped breathing. My assistant had grabbed atracurium instead—a paralytic. Similar name. Both drugs inches apart. High-stress moment. One syllable difference. Potentially fatal outcome. This wasn't human error. This was system error. ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
THE FORCES AT WORK
Operating rooms are noisy. "Atropine" and "atracurium" differ by just
a few phonemes. Under pressure, those differences collapse.
When vitals drop, your brain is processing multiple stressors
simultaneously. Under cognitive load, it takes shortcuts—hears "atra-"
and pattern-matches to the wrong drug.
And here's what made it worse: these two drugs sit inches apart in
our medication tray. We prepare for multiple scenarios, so we keep
common drugs nearby. Good planning creates its own risk.
In medicine, we call this LASA: Look-Alike, Sound-Alike.
It's why medication errors happen even to experienced practitioners.
Not because we're careless. But because under pressure, the brain's
pattern-matching systems work against us.
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LASA RISKS IN MEDICINE
Here are medication pairs that kill people:
→ Atropine / Atracurium (what my assistant confused)
→ Dopamine / Dobutamine (both cardiac drugs, different effects)
→ Epinephrine / Ephedrine (sound similar, different potencies)
→ Hydralazine / Hydroxyzine (completely different drugs)
→ Vincristine / Vinblastine (chemotherapy—wrong one is fatal)
Hospitals have built entire safety systems around LASA risks:
Tall Man lettering: DOPamine vs. DOBUTamine
Physical separation: Keep similar drugs in different locations
Color coding: Different colored caps or labels
Barcode scanning: Computer verification before administration
Mandatory read-backs: Say the drug name out loud, confirm before giving
We don't just tell people "be more careful." We redesign the system
to make errors less likely.
Because if two things CAN be confused under pressure, they WILL be.
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LASA RISKS AREN'T JUST MEDICAL
The same forces exist everywhere.
If two things look similar, sound similar, or sit close together—
under pressure, they'll get confused.
Here's where LASA risks hide in your world:
1. FILE NAMES THAT DIFFER BY ONE CHARACTER
→ Report_Final.docx
→ Report_Finall.docx
Under deadline pressure, you grab the wrong one. Send the outdated
version to the client.
2. PRODUCT CODES THAT LOOK IDENTICAL
→ SKU-10O1 (letter O)
→ SKU-1001 (number zero)
In certain fonts, these are indistinguishable. Warehouse picks the
wrong item. Customer gets the wrong product.
3. MEETING TIMES ACROSS TIME ZONES
→ "Meeting at 3 PM"
→ Is that 3 PM EST? PST? IST?
No clarification. Half the team shows up at the wrong time.
4. AMBIGUOUS PRONOUNS IN INSTRUCTIONS
→ "Send it to him"
→ Which "it"? Which "him"?
Under pressure, assumptions fill the gaps. Usually wrong assumptions.
5. SIMILAR-LOOKING UI BUTTONS
→ "Save Draft" button next to "Delete Forever" button
→ Both red. Both same size. Inches apart.
In a hurry, you click the wrong one. Work lost.
6. NEARLY IDENTICAL EMAIL ADDRESSES
→anand.shankar@company.com
→ anand.shanker@company.com
Send confidential info to the wrong Anand. Data breach.
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THE LESSON I LEARNED
After the atropine/atracurium incident, I didn't just tell myself
"be more careful next time."
I changed the system:
Physical separation: Moved similar-sounding drugs to different
locations. If they're not next to each other, I can't grab the wrong
one reflexively.
Verbal clarity: Stopped saying just "atropine." Started saying
"atropine 0.6 milligrams." The extra specificity reduces confusion.
Closed-loop communication: Instituted mandatory read-backs. I say
"atropine 0.6 mg." Assistant repeats "atropine 0.6 mg—giving now."
I confirm "correct." Only then does it get administered.
Visual distinction: We started using different colour labeled syringes
for different drug classes. Paralytics are one color. Cardiac drugs
another. Visual cue catches errors.
The five seconds these steps take prevents hours of crisis management.
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HOW TO FIND YOUR LASA RISKS
Here's how to audit your environment for LASA risks:
STEP 1: IDENTIFY PAIRS THAT COULD BE CONFUSED
Walk through your workspace. What things:
→ Sound similar?
→ Look similar?
→ Sit close together?
→ Get referenced ambiguously?
STEP 2: ASK "WHAT IF SOMEONE GRABBED THE WRONG ONE UNDER PRESSURE?"
Not "would a careful person avoid this?"
But "could a stressed, distracted, rushed person confuse these?"
If yes, it's a LASA risk.
STEP 3: MAKE DISTINCTIONS OBVIOUS
Don't rely on people being careful. Redesign the system.
Examples:
File names: Not "Contract_v1" but "Contract_DRAFT_2025-02-23"
Buttons: Don't put "Delete" next to "Save"—separate them visually and
spatially
Instructions: Not "Call him back" but "Call Anand at 38383838"
Time zones: Not "3 PM meeting" but "3 PM EST (12 PM PST, 1:30 AM IST)"
Email addresses: Verify with recipient before sending confidential info
Passwords/codes: Use phonetic alphabet over phone: "Oscar" not "O,"
"Zero" not "O"
STEP 4: ADD VERIFICATION LOOPS
For high-risk actions, build in confirmation:
Before sending: "Is this going to anand.shankar@company.com?"
Before deleting: "Are you sure you want to permanently delete?"
Before executing: "Confirming: Transfer INR 10,000 to Account #1234?"
The interruption forces conscious attention. Catches reflexive errors.
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YOUR PRACTICE THIS WEEK
1. FIND ONE LASA RISK IN YOUR ENVIRONMENT
Look for two things that could be confused under pressure:
→ Files with similar names
→ Products with similar codes
→ People with similar names/roles
→ Buttons/controls that look identical
→ Instructions that rely on ambiguous pronouns
2. MAKE THE DISTINCTION OBVIOUS
Don't just "be more careful." Change the system:
→ Rename files with clear, distinct names
→ Physically separate confusable items
→ Use full names, not pronouns
→ Color-code or label clearly
→ Add verification steps for critical actions
3. NOTICE WHAT THIS PREVENTS
Pay attention to moments when you almost grabbed the wrong thing,
clicked the wrong button, sent to the wrong person—but the distinction
you built caught it.
That's the system working.
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THE CORE INSIGHT
LASA risks exist because our brains are optimized for speed, not
precision.
Under pressure, pattern-matching shortcuts kick in. We see "atra-"
and grab atracurium without reading the full label.
We see a file name that starts with "Report_" and assume it's the
current one without checking the date.
We hear "call him" and dial the number we called last time without
confirming which "him."
These aren't failures of intelligence or care. They're features of
how brains work under cognitive load.
The solution isn't to try harder. It's to design systems that make
the right choice obvious and the wrong choice harder.
That's what keeps patients alive when everything else is falling apart.
And it's what prevents errors in your world when pressure is high
and stakes matter.
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NEXT WEEK
Lesson 3: Why precision beats speed—and how one extra sentence prevents
hours of confusion.
Until then—
Dr. Anand Shankar
P.S. — Found a LASA risk in your environment? Hit reply and tell me
about it. I read every response.
Exciting News Coming Up: Look out for my next issues!