AbstractAimsTo observe the extent and the detail with which playing music can impact on communication in the operating theatre.BackgroundAccording to the cited sources, music is played in 53‐72% of surgical operations performed. Noise levels in the operating theatre already exceed World Health Organisation recommendations. There is currently a divide in opinions on the playing of music in operating theatres, with few studies conducted and no policies or guidance provided.DesignAn ethnographic observational study of teamwork in operating theatres through video recordings. Quantitative and qualitative data analysis approaches were used.MethodsThis study was conducted between 2012–2013 in the UK. Video recordings of 20 operations over six months in two operating theatres were captured. The recordings were divided into music and non‐music playing cases. Each case was logged using a request/response sequence identified through interactional analysis. Statistical analysis, using a χ2, explored the difference between the proportion of request repetitions and whether music was playing or not. Further interactional analysis was conducted for each request repetition.ResultsRequest/response observations (N = 5203) were documented. A chi‐square test revealed that repeated requests were five times more likely to occur in cases that played music than those that did not. A repeated request can add 4‐68 seconds each to operation time and increased tensions due to frustration at ineffective communication.ConclusionsMusic played in the operating theatre can interfere with team communication, yet is seldom recognized as a potential safety hazard. Decisions around whether music is played and around the choice of music and its volume, are determined largely by surgeons. Frank discussions between clinicians, managers, patients and governing bodies should be encouraged for recommendations and guidance to be developed.