Saturday, August 20, 2016

Rudeness in Medical Settings Could Kill Patients

Imagine this: You're a cardiac surgeon who is pushing into the five-hour mark of a complicated seven-hour surgery. You ask a nurse for a specific tool, and he drops it. It's now contaminated and useless. The nurse stands dumbstruck until you snap at him to hurry up, grab another tool, and stop being so clumsy. You were rude, but he deserved it, right? He'll get over the uncivil remark and everybody will move on. But that "moving on" actually might not happen — according to a recent study, rude comments in high-pressure medical settings could have potentially deadly effects on patients.

The study, "The Impact of Rudeness on Medical Team Performance: A Randomized Trial," which was published in the September issue of Pediatrics, shows that a rude comment from a third-party doctor decreased performance among doctors and nurses by more than 50 percent in an exercise involving a hypothetical life-or-death situation. "We found that rudeness damages your ability to think, manage information, and make decisions," said Amir Erez, an author on the study and a Huber Hurst professor of management at the University of Florida. "You can be highly motivated to work, but if rudeness damages your cognitive system then you can't function appropriately in a complex situation. And that hurts patients."

For the experiment, Erez and his colleagues gave 24 medical teams from neonatal intensive care units in Israeli hospitals, each composed of one doctor and two nurses, an hour to diagnose and treat a simulated case of necrotizing enterocolitis, a rapid and potentially fatal disease in which a premature newborn's intestinal tissue becomes inflamed and starts to necrotize, or die.

Before beginning, the teams were informed that a leading ICU expert from the United States would be observing them via webcam. The researcher running the experiment then dialed a fake phone number and played a (prerecorded) message that was supposedly from the observer. The message informed half of the participants that he had observed other medical teams and was "not impressed with the quality of medicine in Israel," but told the control group simply that he had observed other teams, without making any rude comments or insults. Ten minutes into the simulation the teams were interrupted by another prerecorded message from the researcher. He told the control group that he hoped the workshop helped them improve as physicians; he told the other teams, however, that the Israeli physicians and nurses he'd been observing "wouldn't last a week" in his department.

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