Even if your doctor doesn’t have the best beside manner, you’re probably willing to excuse her behavior as long as she treats your condition and makes you healthy again, right?
Well, you might not want to be so forgiving. It turns out that rudeness and incivility among doctors, in particular in the operating room, can actually lead to poorer health outcomes and even higher death rates among patients.
Dr. Andrew Klein, director of comprehensive transplant center at Cedars Sinai in Los Angeles, and his colleague Pier Forni, founder of the Johns Hopkins Civility Project at Johns Hopkins University, collected data on previous studies of surgeons’ behavior in the operating room and the subsequent outcomes of the patients on whom they performed procedures. They found that when doctors were more courteous to operating room staff, their patients were more likely to survive and avoid complications than the patients of docs who were O.R. boors.
And the legacy of incivility didn’t stop in the operating arena. In studies of medication orders at hospital pharmacies, the researchers found that 75% of pharmacists and nurses prefer not to confront difficult physicians to ask about potential medication interactions or errors in the prescription. If a doctor who may be making a prescribing mistake goes unchallenged, patients may wind up getting the wrong type or amount of drug — with potentially disastrous consequences.
But it’s the O.R. where manners are worst, and two particular features of the setting conspire to up the obnoxiousness ante. One is the stress of having a patient’s life hang in the balance with every decision, and two, the anonymity of the surgical attire. “Everyone is wearing gowns, gloves, and masks, and it’s a terrific camouflage,” says Klein, who as a surgeon admits to falling into the incivility trap. “Often you don’t know the people you are working with, and you don’t know their names. So if you ask for a clamp and what you get is a clip, the response in many cases is to throw the thing on the floor, maybe with an expletive, and say ‘I said clamp, not clip.’ However, if you knew the person who had handed you the clip, or knew something about his or her family, you wouldn’t act the same way.”
Still, rudeness isn’t entirely the doctors’ fault, since much of it stems from a medical culture in which the surgeon is captain of the ship in the operating room and the doctor on the ward is the arbiter of all medical decisions. The problem is, that structure means that “we are essentially training the next generation of surgeons to be bullies,” Klein warns. In fact, in a recent survey of 1,500 medical students, 42% claimed they had been harassed by superiors and 84% reported being belittled. And other psychosocial studies have shown that people who are humiliated or embarrassed are more likely to want to inflict similar feelings upon others, becoming bullies themselves.
Long before those next generation effects can take hold, incivility infects the hospital culture as a whole, breeding resentment and lack of loyalty. As medical care becomes increasingly complicated, requiring cooperation among health care providers of different specialties, the fractured care that may result doesn’t do the patient any good. In some cases, lives may even be lost. “The challenge for us,” says Klein, “is to nurture the very important surgical traits — ego strength and competence, and a strong work ethic — but in a way that doesn’t abandon our commitment to being civil to one another. “
One way to do that may involve educating surgeons and physicians in positions of authority to accept that their power does not have to be exercised all the time, and that difficult situations and crises can often benefit from a cooperative rather than a dogmatic approach. That’s not an easy lesson for doctors to learn, but it may be a critical one if we want to provide the highest quality health care to patients in the most economically responsible way. “It doesn’t cost anything in terms of taxpayer dollars to be civil,” says Klein. “And if you assume that people in a certain environment will function with civility, then there comes a cost or penalty to those who are not civil.”