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January 20, 2017

Care suffers when providers are faced with rude patients, study suggests

Daily Briefing

    Rude behavior from patients may undercut providers' medical care and can even limit their ability to collaborate as a medical team, according to a study published in the Pediatrics.

    Study details

    For the study, researchers evaluated 39 neonatal intensive care unit teams participating in training workshops. The researchers told the participants they were part of a training exercise for debriefing techniques on how to discuss performance. In reality, the researchers were assessing the teams' response to rude behavior.

    In the workshops, the teams were tasked with providing simulated care for infant mannequins in five emergency conditions, such as an infant suffering from severe jaundice, respiratory distress, or hypovolemic shock. An actress posed as the infant's mother.

    In each workshop, two medical teams were randomly assigned to experience one of two scenarios: a mother making rude comments unrelated to the clinicians' performance or a mother making inoffensive remarks. Meanwhile, two other teams were randomly assigned to complete computer-game or writing-and-discussion exercises to help them cope with rudeness before they had to provide care in the rudeness scenario.

    Judges who observed the workshops rated teams based on metrics such as how well they diagnosed problems, developed treatment plans, shared information, helped one another with patients, and communicated.


    The researchers found that teams who had to deal with rudeness performed worse on 11 of the study's measures. Affected measures included not only "diagnostic and intervention parameters of medical care, but also ... team processes—such as information and workload sharing, helping, and communication—that are central to patient care," according to lead author Arieh Riskin of University of Tel Aviv.

    Such deficiencies were observed across all five emergency scenarios, suggesting that the negative effects of rudeness lasted the entire day, according to the researchers. The researchers estimated that about 40 percent of medical errors stem from patient rudeness.

    Meanwhile, the study found that computer-based exercises in how to deal with rudeness were more effective than discussion-based training.

    The researchers concluded that providers should prioritize training on how to understand and react to rudeness.


    Riskin said the "study is the first to demonstrate what we all feel and know from our experience in our daily practice: that exposure to rudeness inflicted on medical teams by patients or families of patients significantly harm medical teams' performance."

    Study co-author Amir Erez, a University of Florida professor, in a statement said, "People may think that doctors should just 'get over' the insult and continue doing their job. However, the study shows that even if doctors have the best intentions in mind, as they usually do, they cannot get over rudeness because it interferes with their cognitive functioning without an ability to control it."

    Christine Porath, a researcher at Georgetown University's McDonough School of Business who wasn't involved in the study, said while the study demonstrated that providers should be trained on how to best provide care for difficult patients, patients should also be mindful of their behavior. "People—including your child's doctors, nurses, and other clinicians—can't focus or process information as well when they are even around rudeness," Porath said. "Your best shot at great care is to convey your message respectfully" (Bean, Becker's Hospital Review, 1/17; Rapaport, Reuters, 1/10; Caiola, Sacramento Bee, 1/16).

    5 myths physicians believe about patient experience

    5 myths physicians believe about patient experience

    Excellent patient experience is a critical piece of modern medicine, reflected clearly in outcomes. And more than amenities, clean rooms, or quiet during night, the factors that most inflect patient experience all relate to communication and coordination among the care team—factors that physicians are in a unique position to influence.

    Clinician-patient communication, leadership of the care team, and support and empathy for the patient across the unit are the most important factors for success, and they're all driven by the physician as the "Influencer in Chief."

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