Medical Errors a Result of Rudeness

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Exposure to rudeness entailed rude comments from the patient's mother that were completely unrelated to the team's performance.
Exposure to rudeness entailed rude comments from the patient's mother that were completely unrelated to the team's performance.

New research published in Pediatrics has shown that being rude to medical teams may cause "devastating effects on medical performance." 

Of the medical errors committed in the United States, a doctor's poor judgment due to chronic lack of sleep may account for 10–20% of his/her varied performance. Over 40% of it, however, is a result from the effects of rudeness. Researchers from the University of Florida sought to explore the impact of rudeness on medical teams' performance and to assess certain interventions that might mitigate its negative consequences. 

Medical teams from the neonatal intensive care unit (NICU) participated in a training workshop that included simulations of acute care of term and preterm newborns. Each workshop randomized two teams to either an exposure to rudeness or control condition; two additional teams were assigned to rudeness with either a preventative (cognitive bias modification [CBM]) or therapeutic (narrative) intervention. Exposure to rudeness entailed rude comments from the patient's mother that were completely unrelated to the teams' performance. These sessions were evaluated by two independent judges using structured questionnaires to assess team performance.

The data showed rudeness had negative consequences on diagnostic and intervention parameters (mean therapeutic score 3.81±0.36 vs. 4.31±0.35 in controls, P<0.01) as well as team processes (eg, information and workload sharing, helping and communication) that were central to patient care. Most of the adverse effects of rudeness were alleviated with CBM but the post-exposure narrative intervention showed no significant effect. 

The study authors were able to conclude that "rudeness has robust, deleterious effects on the performance of medical teams." Important collaborative mechanisms were hindered after exposure to rudeness. Specific interventions focusing on educating medical professionals to avoid cognitive distraction such as CBM "may offer a means to mitigate the adverse consequences of behaviors that, unfortunately, cannot be prevented," they noted.

Reference

Riskin A, Erez A, Foulk TA, Riskin-Geuz KS, et al. Rudeness and Medical Team Performance. Pediatrics. 2017; doi: 10.1542/peds.2016-2305. [Epub ahead of print]

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