Perceived 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:
- Makary, M. A., & Daniel, M. (2016). Medical error–the third leading cause of death in the US. BMJ. doi:10.1136/bmj.i2139
- 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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