NEW YORK (Reuters Health)—Medical practitioners’ performance suffers when they are exposed to rudeness, new findings show.
Neonatal intensive care unit (NICU) team members who heard disparaging comments while participating in a simulation exercise had lower diagnostic and procedural performance scores compared to team members who didn’t hear rude comments, Dr. Arieh Riskin, of Bnai-Zion Medical Center in Haifa, Israel, and colleagues found. The findings were published online Aug. 10 in Pediatrics.
“It’s part of the culture of medicine in many ways, and the study is important because it demonstrates that this element of physician culture is harmful to patient care,” Dr. Peter Bamberger of Tel Aviv University, a co-author of the study, told Reuters Health in a telephone interview.
While most research on iatrogenic events has focused on how patient-related factors affect the risk of medical errors, some studies have suggested that stressors on practitioners may also play a role, the researchers noted.
To investigate whether exposure to incivility could affect performance, the researchers had 72 NICU professionals at four hospitals in Israel complete an hour-long simulation of caring for a preterm infant with rapidly progressing necrotizing enterocolitis. They were organized into 24 teams of two nurses and a doctor. The “patient” was a mannequin in an incubator, hooked up to standard NICU monitors.
Teams were randomly assigned to the incivility condition or to a control group.
In the rudeness condition, team members heard two comments from a U.S. NICU physician and “visiting expert.” After consenting to take part in the study, but before beginning the simulation exercise, the expert told team members he was “not impressed with the quality of medicine in Israel.”
Ten minutes into the exercise, team members were asked to stop. The expert said that though he liked some of what he saw, the medical staff he’d observed in Israel “wouldn’t last a week” in his department. The experimenters then resumed the simulation task.
In the control condition, team members also heard comments from the visiting expert, but he did not make disparaging remarks.
Among the 39 individuals in the rudeness group, diagnostic and procedural performance scores averaged 2.6 and 2.8, respectively, versus 3.2 and 3.3 for the 33 individuals in the control group. Rudeness accounted for almost 12% of the variance in performance. Further analysis found that the negative effect of rudeness on information-sharing and help-seeking explained much of the difference in both diagnostic and procedural performance (R2=52.3 and R2=42.7, respectively).
“The effect sizes that were generated by a fairly benign comment were roughly twice the size of structural factors that have been examined in the past as determinants of medical error,” such as chronic sleep loss, Dr. Riskin told Reuters Health in a telephone interview.
“Incivility is rampant in our society and almost all people get exposed to it sometime or the other, and medical teams aren’t well aware of how risky it is to our performance,” Dr. Riskin added. Becoming aware of the damaging effects of rudeness on performance is an important first step toward addressing the issue, he and Dr. Bamberger conclude.