The Impact of Rudeness in Medicine

No one likes to be spoken to rudely. It’s unpleasant and unnerving. Although rudeness can hurt our feelings, in medical settings, rudeness can be quite dangerous. In fact, rudeness can cause staff to make mistakes that can lead to patient harm, even death. So what is the possible impact of rudeness in medicine on you and your loved ones? How common is it?

Why is there rudeness in medicine?

Importantly, there are many ways rudeness in medicine can manifest itself. In addition to doctors and nurses being rude to each other, patients and families can be rude to medical staff, and staff can be rude to patients and families.

Why do doctors and nurses act rudely?

One might assume that medical providers are caring professionals who, at a minimum, behave professionally towards each other and to their patients. Sadly and surprisingly, that’s far from the truth.

Why do medical staff act rudely? It’s not just one thing. A variety of factors can cause staff members to be rude – to each other and to patients and families, including:

Workload

Being a doctor or nurse is very stressful. They face daily challenges, including:

• Long, physically demanding workdays.
• Responsibility for patients’ lives.
• Patient deaths, despite their efforts.
• Enormous amount of administrative work, often using electronic health records that are poorly designed.
• Little or no time to break for meals or even the bathroom.

And COVID-19 has made everything even more stressful. However, I think it’s clear from this list that doctors and nurses have difficult jobs that could lead them to express themselves rudely.

Human nature

Certainly, doctors and nurses are people just like the rest of us, and may experience insecurity, anxiety, depression, aggressiveness, and narcissism, each of which can manifest itself as rudeness. Additionally, cultural, generational, and gender biases can contribute to disrespectful behavior.

Hierarchy

The hierarchy in place in healthcare settings, along with a sense of privilege and status, can lead those at the top of the hierarchy to treat those lower on the hierarchy with disrespect.

Culture

The hierarchical hospital culture creates a place where disrespect is learned, tolerated, and reinforced. For instance, power dynamics, a “culture of silence”, poor leadership, and “power cliques” all contribute to staff rudeness. Moreover, some hospitals do not discipline doctors for rude behavior, although nurses can face discipline or even lose their jobs.

Why do patients act rudely towards doctors and nurses?

There are many reasons patients and family act rudely towards medical staff, including fear, frustration, pain, mental illness, infection, or other complex social, physical or mental issues.

Rudeness in medicine: between doctors and nurses.

Unfortunately, rudeness among medical staff is widespread. For example, in a 2020 survey of 7,680 emergency medicine residents, 45% reported exposure to some type of workplace mistreatment (eg, discrimination, abuse, or harassment). Moreover, 2.5% reported having suicidal thoughts during the most recent academic year. Interestingly, the prevalence of workplace mistreatment or suicidal thoughts was similar for all genders and race/ethnicity.

A 2022 Medscape survey of over 1,500 doctors found widespread misconduct among doctors, with a recent increase in prevalence. Here is what the doctors reported:

• 41% have seen other clinicians behave inappropriately in the workplace (a 35% increase over 2021).
• 86% said they saw colleagues bullying or harassing other clinicians in the past 5 year. And 30% said they saw a recent increase in this kind of behavior.
• 45% said they saw colleagues bullying or harassing patients in the past five years, with 5% noticing a recent increase.
• 55% report they heard colleagues using racist language in the past five years, with 9% noting a recent increase.
• 44% state they saw colleagues becoming physically aggressive with patients, other clinicians and staff. And 6% have seen a recent increase.

And in a 2015 study, 31% of doctors describe being subject to rude, dismissive and aggressive communication multiple times each week.

Finally, in a 2009 American College of Physician Executives survey of doctors and nurse, nearly 98% of respondents reported witnessing problematic behavior between doctors and nurses in the past year.

Interestingly, while there were comments regarding rude nurses, both doctors and nurses reported that doctors were to blame for a large part of the disruptive, rude behaviors. Many respondents accused doctors of belittling and patronizing nurses.

Unsurprisingly, the respondents stated the basic lack of respect between doctors and nurses was a huge problem affecting every part of their jobs.

In what ways do doctors and nurses treat each other rudely?

In the 2009 American College of Physician Executives survey, doctors and nurses shared their experiences with rudeness, including:

• Doctors groping nurses and technicians as they tried to perform their jobs.
• Tools and other objects being thrown across the operating room.
• Personal grudges interfering with patient care.
• Accusations of incompetence or negligence in front of patients and their families.

The most common complaints identified in this survey were degrading comments and insults (85%) and yelling (73%). Other common complaints included refusal to work together, refusal to speak to each other, cursing, and inappropriate joking.

Alarmingly, some of the behaviors mentioned by the respondents are criminal and could meet the criteria for an assault charge. For example, respondents shared stories of co-workers throwing scalpels and other instruments. One report stated that someone squirted a used syringe in a co-worker’s face.

As potentially dangerous as some of these incidents appear, some survey participants stated that it was the day-to-day putdowns and slights that felt the most harmful.

Racism in the workplace.

Unfortunately, racism is commonplace.

In a 2021 survey of nurses from the National Commission to Address Racism in Nursing, nurses of color reported widespread discrimination. Alarmingly, the number of nurses reporting personal experiences with racism are high, as follows:

• 63% of respondents of all races.
• 92% of Black nurses.
• 74% of “other” or multiple races.
• 73% of Asian nurses.
• 69% of Hispanic nurses.
• 28% of white nurses.

Importantly, 66% of Black nurses reported an experience with racist acts from a peer, 70% reported racist acts by a manager or supervisor, and 68% reported racist acts by patients.

Unfortunately, doctors of color experience racism as well. A 2020 study found that a majority of doctors of color experienced significant racism from their patients, colleagues, and institutions. However, participants reported they were more likely to experience racism from their colleagues than from their patients.

Rudeness in medicine takes its toll on the recipient and witnesses.

Research shows that being disrespected by co-workers causes the recipient to experience fear, anger, shame, confusion, uncertainty, isolation, self-doubt, depression, and a whole host of physical ailments, including insomnia, fatigue, nausea, and tension.

Additionally, those who witness rude behavior can suffer from emotional harm as well.

Rudeness in medicine impacts job performance.

Unsurprisingly, doctors and nurses say that in addition to rudeness harming their mental health, rudeness also hurts their productivity. In one study, 40% of respondents stated that rude, dismissive and aggressive communication moderately or severely affected their working day.

Additionally, ongoing rudeness leads to absenteeism and resignations, which can further the widespread staff shortages seen in hospitals across the US.

Unfortunately, rudeness spreads in hospitals like a contagion, and negatively impacts a person’s working memory. How? Stress on the brain makes it hard to learn, reason, comprehend, and recall information. Without a doubt, this decrease in thinking skills can affect performance and thereby harm patients.

Rude comments can cause medical staff to experience the following issues, all of which can negatively impact patient care and health:

• Difficulties cooperating and communicating.
• Difficulties getting their jobs done effectively.
• Misdiagnosing an illness.
• Forgetting instructions.
• Not asking for help when needed.
• Doctors asking for the wrong medication.
• Nurses mixing the wrong medication.
• Difficulty properly ventilating a patient.
• Not resuscitating the patient well.

Studies demonstrate the impact on performance.

In one study, researchers observed medical teams as they performed in a simulated life-or-death situation in a neonatal intensive care unit (NICU). Interestingly, the study found that a rude comment, made by an outside observer posing as a parent, significantly decreased both the doctor’s and the nurse’s performance.

The study showed the direct effect of rudeness on cognitive functions and individual performance. These highly trained NICU doctors and nurses had a significant decline in their ability to resuscitate newborns or diagnose life-threatening complications after hearing rude comments. Moreover, they found that even mild rudeness negatively impacted performance.

Importantly, one of the study authors thinks that more than 40% of medical errors are caused by the effects of rudeness.

Similarly, a 2019 study measured the performance of anesthesiology residents during a simulated operating room crisis. The residents were randomly assigned to either a ‘normal’ or ‘rude’ environment. Researchers found the rude environment had a negative impact on performance, including a degradation in vigilance, communication, and patient management. Interestingly, the participants had no sense of these negative effects on their performance.

Rudeness discourages collaboration.

Disrespectful behavior discourages communication and collaboration, undercuts individual contributions to care, undermines staff morale, and creates an unhealthy or hostile work environment.

For instance, in the NICU study, the researchers found that rudeness harms collaborations, such as communication, workload sharing, and helping each other.

It’s not surprising that fear of a negative reaction could deter doctors and nurses from sharing their concerns or opinions. But collaborations are important and can make team-based medical care more effective and safer than care provided by individuals. For example, one study found that among other factors, decreased consultations, poor communication, and a lack of collaboration and teamwork can cause poorer patient outcomes.

Simply put, quality healthcare relies on good communication between all members of the healthcare team. If doctors or nurses don’t speak up and collaborate with their co-workers, patients may suffer unnecessarily.

Examples of the impact on patients.

Certainly, rude behavior between doctors and nurses impacts patients and families, as does rudeness towards patients and families. Possible harm ranges from patients and families hearing mean, insensitive comments to life-threatening patient harm. Sometimes patients witness rudeness firsthand, and other times it happens behind the scenes.

In the 2009 American College of Physician Executives survey, respondents reported that both doctors and nurses are guilty of putting patients in uncomfortable and downright dangerous situations.

Here are two examples:

Shockingly, one respondent shared a story about a baby who needed immediate attention from a doctor. With the mother looking on, the doctor berated the nurse by saying, “What did you do to kill this baby?”. The infant later died.

Another respondent shared a story about an ICU nurse who called the doctor to report a patient experiencing problems after surgery. The doctor yelled at the nurse and refused to see the patient. When the patient’s condition worsened, the nurse tried the doctor again, who became even more verbally abusive. The nurse hesitated to call the doctor again for fear of abusive behavior. When the nurse finally called the doctor, it was too late. The patient, who was bleeding internally, was rushed back to the operating room where he died.

What if you witness rude behavior between doctors and nurses?

Certainly, the impact of rudeness in medical settings can be hard to avoid, particularly if you are not aware of the bad behavior.

Witnessing rude behavior among medical staff is a tricky situation. It’s not a good idea to intervene, but it doesn’t mean you are completely powerless. If you are in the hospital and witness abusive behavior, you can contact the hospital’s ombudsman. Share your concerns with as many details as possible. If you feel your health is in danger, say so!

If a doctor or nurse is making you uncomfortable and/or you feel concerned for your health, ask to have your care transferred to a different doctor or nurse.

What should you do if doctors and nurses treat you rudely?

I think it’s safe to say that we’ve all experienced a doctor or nurse with a “bad bedside manner”. Is it rudeness or a quirky personality? Either way, if you can’t have a respectful relationship with your doctors and nurses, it’s time to consider your options.

That being said, sometimes you might be stuck with a rude doctor because of a rare medical condition and/or your geographic location. But in general, you should find a doctor who treats you with respect.

So, what can you do if a doctor or nurse treats you rudely?

In general, if a doctor or nurse treats you with rudeness on an ongoing basis, you should speak up.

If your primary care doctor or a needed specialist consistently behaves rudely, it might be time to find a new doctor. If a nurse in the practice is rude, mention it to your doctor. He/she will want to know – customer service and patient experience are considered high priorities in most practices. (Read this 3-part series on when to change doctors: Part 1, Part 2 and Part 3.)

And if you’re in the hospital and a nurse treats you rudely, share your concerns with the head nurse. Ask to be assigned to a different nurse. And if they won’t assign you a new nurse and the rude behavior continues, reach out to the hospital ombudsman.

Similarly, if you’re in the hospital and a doctor is repeatedly rude to you, report the behavior to a senior doctor and/or the ombudsman. Ask for another doctor to be assigned to your case.

Importantly, don’t just grin and bear any repeated, rude behaviors. Because as we’ve seen, not only is rudeness unpleasant, it’s also potentially dangerous to your health.

Rudeness in medicine: Patients and families play a role.

Unfortunately, patient and family behaving rudely in medical settings is more common than you might expect.

For instance, a 2017 WebMD/Medscape survey found that doctors and other healthcare professionals experience widespread mistreatment from patients. For example, 59% had heard offensive remarks about a personal characteristic in the past five years — mainly about their age, gender, race, or ethnicity.

Additionally, in a 2018 survey of surgical residents, 32% reported discrimination based on their self-identified gender, and 17% reported racial discrimination. Additionally, 30% reported experiencing verbal or physical abuse (or both), and 10% reported sexual harassment.

Unsurprisingly, women reported mistreatment more often than men. In fact, 65% of the women reported gender discrimination and 20% reported sexual harassment. Patients and their families were the most frequent sources of gender discrimination and racial discrimination (but attending surgeons were the most frequent sources of sexual harassment and abuse).

Moreover, in the 2021 survey from the National Commission to Address Racism in Nursing, 68% of Black nurses reported racist acts from patients.

And in a 2020 study of racism against doctors of color, 23% of participants reported that a patient directly refused their care specifically due to their race.

How could your rudeness impact the quality of care you receive?

Importantly, when patients and family members make rude comments to staff, it can lower the quality of care provided. As we saw in the NICU simulated study, rude comments from an actor posing as a family member significantly decreased the doctors’ and the nurses’ performance. And the study authors see a strong connection between rudeness in medicine and medical errors.

Why would you ever make comments that could harm your health?

Try your hardest not to add to the rudeness in medicine problem!

Never be rude to any medical provider – for your own sake and for theirs. It’s not okay.

Kindness towards medical staff has never been more important. In the midst of the COVID-19 pandemic, doctors, nurses, and other staff members are working in extremely stressful work conditions while dealing with widespread staff shortages.

Even if doctors, nurses, and other staff members are rude to you, don’t behave rudely in response. I know, it’s tempting. But realize that medical providers have very stressful jobs, and they’re human beings like the rest of us. However, you don’t have to tolerate rudeness in medicine either. As mentioned above, if a doctor or nurse treats you rudely, you have options.

Learn more.

Since how you interact with your doctors can impact your health, read these posts for tips:

• Are Patients Biased Against Doctors with Particular Characteristics?
• How Do You Treat Your Doctors?
• Why are Doctor-Patient Relationships Vital?
• 10 Tips to Communicate Better with Doctors.
• 10 Tips for a Better Medical Appointment.
• Doctor Burnout Can Impact Your Health.

NOTE: I updated this post on 11-1-22.