Why Rudeness Hurts

Can kindness cure? It sure may help in the operating room, a new study published in the journal Pediatrics suggests.

Researchers in Israel found that incivility among a medical staff diminishes team cooperation, harms performance, and can have “potentially devastating” effects on patient care.

The study was led by researchers at Tel Aviv University. It examined the performances of 24 neonatal intensive care unit teams that participated in a simulation exercise with a premature infant suffering from necrotizing enterocolitis, a common yet life-threatening complication. Each team was told an expert would observe their performance and diagnostic capability during the exercise.

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Half the teams were exposed to an expert who spewed rude comments during the procedure. The other half — the control group — were observed by a neutral expert. Independent judges, blind to each group’s exposure category, later evaluated the teams’ performances.

Rudeness in operating room explains more errors than lack of sleep.

The results were conclusive: The teams exposed to the discourteous expert performed worse. Incivility in the operating room impeded information-sharing among the medical team, decreased diagnostic accuracy, and reduced the quality of patient care.

“Seemingly benign rudeness has robust adverse effects on the performance of medical team members, explaining far more of the error in diagnosis and practice than other factors examined to date (e.g., lack of sleep),” said professor Peter Bamberger, one of the study’s authors.

Rudeness in the operating room put the infant patient — in this case a medical mannequin — at risk. According to the study, “Rudeness alone explained nearly 12 (percent) of the variance in diagnostic and procedural performance.”

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“The mechanisms underlying these effects appear to be cognitive in nature, with rudeness making it more difficult for team members to engage in those team processes — such as workload and information sharing — that are often critical for medical team performance,” Bamberger told LifeZette.

But how common is rudeness and incivility in actual hospital settings? According to several studies, it’s a bigger problem than we may think. The study’s authors called it “rampant.”

Rudeness undermined critical factors like workload and information sharing.

A 2009 survey by the American College of Physician Executives found that of the roughly 2,100 doctors and nurses who responded, 85 percent reported hearing degrading comments or insults at work, and 73 percent said yelling was not uncommon. Ninety-eight percent reported witnessing behavior problems between doctors and nurses in the past year. One of the most common complaints came from nursing respondents, who said doctors often refused to listen to or respect nurses.

Samantha Mehlman, a registered nurse at New York Presbyterian Hospital, said she’s seen doctor-nurse tension firsthand, but thought that lack of communication was a bigger issue than overt rudeness.

“In terms of the interdisciplinary rudeness, you can only hope that the mission to give the patient the best care doesn’t get compromised,” she told LifeZette.

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Several studies have shown that productivity, creativity, and idea creation decline when workers in any workplace are exposed to discourtesy or feel disrespected on the job. “Nearly everybody who experiences workplace incivility responds in a negative way, in some cases overtly retaliating,” notes an article in Harvard Business Review.

But when the workplace is a hospital, the stakes are higher, as any decline in performance puts lives at risk.

“Harmony between staff members is essential,” Dr. Brunno von Ristow, chief emeritus of plastic surgery at California Pacific Medical Center in San Francisco, said in an interview with LifeZette. “In medical settings, animosity between the personnel must be curtailed, because patients are very sensitive and attuned, and quickly perceive issues. This is detrimental to their recuperation.”

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The Israeli researchers hope their findings will shed light on the negative consequences of discourteous and disrespectful behavior among medical teams and the “need to shift behavioral norms in medical contexts.” The study’s authors want future research on medical error to take into account the quality of medical teams’ interpersonal interactions and attitudes.

At a minimum, the study gives doctors another reason to be nice.

“The findings suggest a greater need to look at the interpersonal relations and interaction (and more specifically, their cognitive implications) as critical risk factors,” Bamberger told LifeZette.

A little kindness goes a long way, as the saying goes — and in the operating room, it might even save lives.