Why being rude to doctors is bad for them and you

Doctors don’t just “get over” rude treatment from patients, research suggests. In simulations with an angry parent, the performance of pediatricians suffered dramatically.

The findings reinforce past research that rudeness has “devastating effects on medical performance,” says Amir Erez, management professor at the University of Florida, who worked with doctoral student Trevor Foulk.

A Johns Hopkins University study estimated that more than 250,000 deaths are attributed to medical errors in the US annually—which would rank as the third-leading cause of death in the US, according to statistics from the Centers for Disease Control and Prevention.

Some errors could be explained by a doctor’s poor judgment due to a chronic lack of sleep. Those types of circumstances, according to prior research from Erez and Foulk, account for about 10 to 20 percent of the variance in practitioner performance.

The effects of rudeness, Erez says, account for more than 40 percent.

“[Rudeness] is actually affecting the cognitive system, which directly affects your ability to perform,” Erez says. “That tells us something very interesting. People may think that doctors should just ‘get over’ the insult and continue doing their job. However, the study shows that even if doctors have the best intentions in mind, as they usually do, they cannot get over rudeness because it interferes with their cognitive functioning without an ability to control it.”

In a previous study, Erez and Foulk examined the effects of rudeness from a colleague or authority figure on individual medical professionals. This study analyzed team performance and the effects rudeness has when it comes from a patient’s family member.

NICU emergency scenarios

In the new study, 39 neonatal intensive care unit teams (two doctors and two nurses) from Israel simulated five scenarios where they treated infant medical mannequins for emergency situations such as severe respiratory distress or hypovolemic shock. An actress playing the baby’s mother scolded certain teams while the control groups experienced no rudeness.

Erez and Foulk found that the teams that experienced rudeness performed poorly compared to the control groups. The teams that encountered rudeness were deficient in all 11 of the study’s measures, including diagnostic accuracy, information sharing, therapy plan, and communication, over the course of all five scenarios showing that the negative effects last the entire day.

To combat the effect of rudeness, the researchers included “interventions” for selected teams. Some teams participated in a pre-test intervention that consisted of a computer game based on a cognitive-behavioral attention modification method intended to raise the threshold of the participants’ sensitivities to anger and aggression. Other teams participated in the post-test intervention, which consisted of team members writing about the day’s experience from the perspective of the baby’s mother.

Erez and Foulk found no difference in the performances of the control groups and the teams that played the computer game. The teams recognized the mother’s rudeness—both midway and after the simulation—but were not affected by it.

“It’s really shocking how well it worked,” Erez says. “They were basically immunized from the effects of rudeness.”

Conversely, the post-test intervention, which research has shown to be extremely successful for victims of trauma, actually had a negative effect on teams.

“What is really concerning is that, at midday, these teams recognized the mother was rude to them,” Erez says. “But at the end of the day, they did not. So not only did it not work, but it caused them to not recognize rudeness later.”

Rudeness training

Considering the researchers’ findings and the large number of deaths attributed to medical errors, teaching medical professionals to handle rudeness more effectively should be a priority for the medical community.

“In the medical field, I don’t think they take into account how social interactions affect them,” says Erez, “but it’s something they’re starting to pay attention to. The purpose of this research was to identify what’s going on here. Now that we’ve found serious effects, we need to find more realistic interventions.”

Arik Riskin, a professor of neonatology at the Technion, Israel Institute of technology, and Peter Bamberger, a professor of management at Tel Aviv University in Israel, also collaborated on this research. The study appears in the journal Pediatrics.