In medicine, rudeness may hurt more than feelings

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Like all professions, medicine has its fair share of office politics — which can generate sniping, griping, eye-rolling and even the occasional temper tantrum. Yet, in a medical setting, can day-to-day rudeness do more than cause hurt feelings and wounded pride? Applying findings from several studies analyzing the cognitive impact of negative interactions, Rhona Flin, a professor of applied psychology at the University of Aberdeen’s King’s College, argues in an editorial published this week in BMJ that not only do harsh words and incivilities create a hostile work environment, but in surgical settings, they may ultimately jeopardize the health of the patients.

To emphasize just how distracting rude or heated workplace interactions can be, Flin starts the editorial by recounting the now infamous case of the two Northwest Airlines pilots who were so engrossed in a cockpit debate that they overshot their destination airport by 150 miles. She writes: “Whatever caused their lack of attention, the story illustrates the interplay between emotionally charged behavior, namely arguing or rudeness, and cognitive skills, such as concentration.”

And, as it turns out, rudeness is pretty commonplace in the workplace, Flin points out, referring to a poll of 800 North American employees that showed 1 in 10 witnessed incivility on the job on a daily basis. Specifically in surgery, the problem also appears routine — Flin highlights a poll of 391 operating room staff with the U.K.’s National Health Service (NHS) showing that nearly two thirds had witnessed operating room arguments between nurses and surgeons, while more than half said they’d been on the receiving end of aggressive behavior from superiors.

So how does this squabbling impact patient safety? According to a July 2008 report from the Joint Commission, the organization which accredits medical programs in the U.S.:

“Intimidating and disruptive behaviors can foster medical errors, contribute to poor patient satisfaction and to preventable adverse outcomes, increase the cost of care, and cause qualified clinicians, administrators and managers to seek new positions in more professional environments.”

While an emerging field of patient-safety related research is beginning to further address this issue, Flin points to findings from studies in non-medical settings suggesting that the ensuing stress negatively impacts performance. In one study, students who were insulted en route to take an exam performed significantly worse than those in a control group, for example. In another experiment, students witnessed a rude interaction — not directed at them — immediately before taking a test. Researchers found that those students fared far worse on the exam than those who hadn’t heard the heated interaction. Extrapolating from the findings, Flin writes:

“The study suggests that in confined work areas, such as operating theaters, even watching rudeness that occurs between colleagues might impair team members’ thinking skills. In surgical environments, all staff require high levels of attention and memory for task execution—for example, [anesthesiologists] remembering to administer drugs or nurses counting instruments. If incivility does occur in operating theaters and affects workers’ ability to perform tasks, the risks for surgical patients—whose treatment depends on particularly high levels of mental concentration and flawless task execution—could increase.”

Maximizing patient safety means not only ensuring optimal medical training and surgical protocols, but cultivating an atmosphere that enables medical professionals to do their best work, Flin concludes.