How Rudeness in Health Care Can Hurt Patients

Say you're at work, at a training workshop. You're told that a visiting expert will be observing you. Just before the training starts, he makes a brief statement, telling you and your colleagues that he's "not impressed" with the quality of work he's seen at your organization.

Rude, huh? Maybe upsetting? But would such behavior affect how you do your job?

A new analysis published Monday in the journal Pediatrics found exactly that -- even mild rudeness can have "adverse consequences" on how medical teams diagnose and treat patients.

The experiment that they devised was quite specific: The researchers invited doctors and nurses from the neonatal intensive care unit to a training and disclosed that an outside expert would be studying them. Participants were split into two groups -- one group had the "rudeness" intervention, the other did not.

Ten minutes after delivering the statement above, the visiting expert also told the intervention group that judging from what he'd seen, the teams "wouldn't last a week" in his department at home.

Each group then worked on a mannequin of a 28-week premature infant who had developed necrotizing enterocolitis -- death of intestinal tissue, a serious condition that kills one in four babies who develop it. Their tasks were to diagnose, rapidly and accurately, what was happening to the baby, to determine a course of treatment and correctly perform the treatments.

The team that had experienced rudeness performed worse than the control group across a variety of measures, including getting the diagnosis right, performing resuscitation, asking for the right lab tests and much more.

Such rudeness is a distraction and affect people's "cognitive resources," said study author Peter Bamberger, a professor of organizational behavior at the Tel Aviv University School of Management. "Negative interactions in the workplace draw from those resources and put patients at risk because those caring for (patients) just aren’t able to make decisions or process information the way they should,”

He said he was surprised by the magnitude of the finding.

“Rudeness is a very mild form of incivility," he said. "The statements that were made [in this study] were kind of tactless. This rudeness was really mild -- and the effects were huge."

Bamberger and his colleagues put their study squarely in the frame of patient safety. They noted that while there had been "some modest improvements" since the seminal 1999 Institute of Medicine Report "To Err Is Human" tallied as many as 98,000 deaths a year due to patients error, significant gaps in safety remain.

They wrote that they suspected that one major reason was because "many of the improvements were directed at refining systems and technologies, while neglecting human/relational factors."

Dr. Calvin Chou is a professor of clinical medicine who teaches bedside manner courses to physicians at UC San Francisco. Chou said that while many researchers are looking at ways to improve the quality of care, many efforts are simply window dressing.

“This [study] is just emblematic of how complicated health care is and the many different factors that can go into the quality of health care," Chou said, and added that "interpersonal communication is key."

Bamberger said that it was not just physicians and nurses who need to watch their manners, but that rudeness from patients and families matters too -- although teaching staff to better handle negative interactions with patients and families could help.

“When people are in those kinds of situations where patients’ lives are at stake, emotions sometimes get the best of people," Bamberger said. "Efforts have to be made to try to educate all of those involved in those situations to try to show a little bit more care towards one another.”