Patient Rudeness Worsens Medical Care, but CBT Can Help

Doctor talking with patientPerceived patient rudeness can negatively affect patient care, according to a study published in the journal Pediatrics. The study’s authors say doctors’ emotional reactions to patient rudeness can disrupt their judgment, accounting for about 40% of medical errors. Previous research points to medical error as the third-leading cause of death in the United States, claiming more than 250,000 lives per year.

The study also found cognitive behavioral therapy (CBT) could mitigate the negative effects of patient rudeness.

How Rudeness Undermines Doctors’ Judgment

The study looked at patient-doctor interactions at 39 neonatal intensive care unit (NICU) teams in Israel. In each unit, a doctor and two nurses simulated five scenarios in which an infant—played by a mannequin—required emergency medical treatment. An actor playing the parent of the mannequin child berated some medical teams, but not others.

Researchers then assessed the medical teams on 11 dimensions of quality care, such as communication and diagnostic accuracy. Compared to medical teams that experienced no rudeness, those who were scolded performed worse on all 11 measures of care. These deficiencies persisted through all five scenarios, suggesting a single rude patient can harm a medical professional’s performance all day.

Mitigating the Effects of Patient Rudeness

Researchers also designed a cognitive behavioral intervention to offset the effects of patient rudeness. Before the five treatment scenarios, some teams played a computer game designed to reduce anger and aggression. Others wrote about the day from the perspective of the parent after the treatment scenario.

Medical teams who played the game still recognized the parent’s behavior as rude. However, the game improved the teams’ performance so those who experienced rudeness performed as well as those who did not.

The exercise encouraging medical providers to see things from the parent’s perspective did not have any positive effect on patient care. The medical teams recognized the parent’s behavior as rude in the middle of the day. By the time they did the exercise, however, they no longer recalled the rudeness. This suggests the rudeness affected them even though they did not remember experiencing mistreatment.

NICUs are usually high-stress environments, with medical providers facing a range of pressures. Anxious parents may take their stress out on providers. If a simple CBT intervention improves performance, it could reduce stress for parents and providers alike, while improving outcomes for babies.

References:

  1. Makary, M. A., & Daniel, M. (2016). Medical error–the third leading cause of death in the US. BMJ. doi:10.1136/bmj.i2139
  2. Riskin, A., Erez, A., Foulk, T. A., Riskin-Geuz, K. S., Ziv, A., Sela, R., . . . Bamberger, P. A. (2017). Rudeness and medical team performance. Pediatrics. doi:10.1542/peds.2016-2305

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  • Caroline

    Caroline

    January 24th, 2017 at 11:32 AM

    I don’t care what kind of therapy helps- when a patient comes into the office and is immediately rude to me I seriously have to take a deep breath and count to 10. I am never quite sure why they think that being rude will get them anywhere?

  • Juliet

    Juliet

    January 25th, 2017 at 10:34 AM

    CBT but for whom?
    the patients or the caregivers?

  • shelby

    shelby

    January 25th, 2017 at 2:22 PM

    I know that patients get frustrated but at my office it always seems to be about the smallest things, mostly things that are related to their insurance but never with us.
    So why take all the anger and frustration out on us?
    Maybe this is how CBT can help someone, to help them see that in order to obtain results you have to mostly direct the behavior at then entity which can change things for you and not someone whose hands are already tied by red tape.

  • Cora

    Cora

    January 26th, 2017 at 1:53 PM

    These are people who technically hold my life in their hands, why am I going to be ugly to them?

  • Joseph

    Joseph

    January 28th, 2017 at 4:55 PM

    For any medical provider I would think that they are not all that concerned with if a person is being rude.
    They just want to know that they can help them to feel better

  • Marvin

    Marvin

    January 30th, 2017 at 10:26 AM

    People complain all the time about how they are not receiving positive care from their doctors offices but do they ever stop to think about how much their own actions could be causing this?

    No one really wants to be around such a negative and complaining person all the time and so you just do what you can to get them seen and in and out the door as quickly as possible.

    Perhaps if they would try to be a little more cheerful then they would overall be better satisfied with the outcome and care.

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