Communication failures are a known problem in operating rooms, with past studies examining the role of checklists, briefings, and surgical teamwork training as potential solutions. Interprofessional conflict can be a mediating factor in such failures, and this ethnographic study aimed to describe what the authors refer to as “silences” as a root cause of such conflict. Based on observations of communication between nurses and surgeons from more than 700 procedures, the investigators describe how silences stem from many factors, including fear, powerlessness, or as a strategic means for exerting or resisting power. A past Agency for Healthcare Research and Quality WebM&M commentary discussed a case of “silence” when members of the operating room team were reluctant to speak up to a senior surgeon.