A while back, I had a patient that really rubbed me the wrong way. Everything she did and said, including her tone and manners toward my staff was rude, frustrating and downright annoying. It was everything I could do from becoming rude myself. Luckily, I made it through the encounter without saying something dumb myself.

I was thinking about my angry encounter during a resident workshop one of my college partners and I were running. We spend a lot of time teaching residents how to do surgical procedures, biomechanical examinations and taking histories and physicals among many other technical skills. Yet we spend very little time practicing the best ways to deal with patients under difficult conditions.

In order to help my residents learn important patient care skills, we did a simulation workshop in which they were paired up together, with one resident being the “doctor” and the other “the patient.” Without foreknowledge of what they were doing, we had them simulate discussions such as a surgical complications (postoperative metatarsal osteotomy displacement), preoperative consent, a patient who needs a below knee amputation and a suspected child abuse case. I wanted my residents to go through these scenarios as practice instead of doing it in real life for the first time (most of these have happened to me while in practice). We videotaped their simulations and then played back portions, with each resident receiving feedback about body language, verbal cues and strategies to handle these difficult situations. I’m happy to say they did very well.

During a few of these simulations, the “patient” was instructed to be difficult, and my resident actors really bought into their roles. The one thing my resident physicians did not do, though, was become rude. Perhaps it was the situation (two of their attendings watching) or maybe they knew how to keep their emotions in check, but my residents seemed to know implicitly what researchers recently found: rudeness can kill.

Riskin and colleagues recently examined the effect of rudeness on the performance of 24 teams in neonatal intensive care units¹. The teams were given a simulation in which a newborn baby’s condition rapidly deteriorated. Teams were randomized to either having a known observer who made rude statements unrelated to the teams’ performance or a control with a neutral observer. The simulations were videotaped and blinded expert observers evaluated the teams’ performance.

Teams exposed to rudeness suffered lower diagnostic and procedural performance scores compared with those exposed to a neutral observer (about 12% lower).

What does this have to do with us? It is easy to extrapolate from the lower performance of professional NICU teams exposed to rudeness to our everyday interactions with patients and other medical professionals. Rudeness adds a significant negativity factor, which affects our ability to make decisions.

When I was a resident, I had one particular attending that was constantly, uniformly rude and sometimes verbally abusive to not only the residents but also other hospital staff. Looking back on this person’s effect on the operating room function, it is clear that it compromised many aspects of these surgeries.

One may realize intuitively that we are not able to do our best work when under large amounts of unnecessary negative pressure from a rude person. How can I decide what the next part of the surgery should be when I’m being disparaged?

I can also tell you that situations such as this were deciding factors on choosing which residency I did. When I was a student, I visited a program and met a particular attending physician. While in his office, I asked a poorly worded question and received an inordinately rude and hostile response. I decided then and there that particular program wasn’t worth my time. If they could act that way to a student visiting for a few hours, imagine what they’d do to their residents?

In the office, I try to approach hostile or rude patients with much the same methods I was taught in my teenage years working at a fast food restaurant (you can’t imagine how rude people can be when they’re hungry). Here are a few tips to help keep you out of trouble with these difficult patients. These may seem obvious, but I’ve seen grown professionals turn into fools in the presence of rude and hostile patients. A few obvious rules will go a long way.

1. Remain calm. At all costs, don’t let your patient make you too angry to think straight. This is the road to pain and suffering.
2. Isolate the patient. If a confrontation is occurring in a public area with other patients present, bring your arguing patient to a separate location. You don’t want a scene.
3. Let the patient speak. Some people are rude because they want to be heard but are unable to express that desire. Simply listening may diffuse their belligerence.
4. Establish your perspective respectfully. You have a right to your opinion, so let that be known but with the appropriate respectful tone.
5. Ask the patient what he/she would like. What would satisfy them? If it’s a reasonable request, then you can consider acquiescing.
6. Explain from your professional opinion what should/needs to be done. Explain how you both can work as a team to affect the best outcome for the patient.
7. Offer a break. If a stalemate occurs, recommend taking a few minutes break. This will give them a chance to calm down and you to gather your thoughts.
8. NEVER use or allow expletives or frankly abusive language or actions. The use of inappropriate language is a conversation ender. They say, “#@$%#,” you say, “This is the end of our discussion. Leave now.” Call security or the police if the confrontation appears to be escalating to the violent. Yours and your staff’s safety are paramount.

Sticks and stones can break my bones, but names will never hurt me, goes the old rhyme. But as new research and many of our own experiences prove, it appears the negativity of rudeness does in fact have a significant effect. It’s an unfortunate part of being a healthcare provider, but following a few common sense rules will save a lot of heartache.

Best wishes,

Jarrod Shapiro, DPM
PRESENT Practice Perfect Editor
[email protected]

1. Riskin A, Erez A, Foulk TA, et al. The Impact of Rudeness on Medical Team Performance: A Randomized Trial. Pediatrics. 2015 Sep;136(3):487-495.