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Emotions can run high in the hospital where a lot can be at stake. Sometimes, patients or their families can be rude to medical personnel despite no one in particular being at blame. Blowing steam in the hospital, however, can have grave consequences, a new study found. According to the University of Florida researchers, the feelings doctors get after being scolded can’t be shaken off easily and this affects their performance for the worse. In fact, it could lead to otherwise preventable deaths.

A seminal John Hopkins study found 250,000 annual deaths in the U.S. can be attributed to medical error making it the third-leading cause of death in the U.S.

“Medical error has been defined as an unintended act (either of omission or commission) or one that does not achieve its intended outcome, the failure of a planned action to be completed as intended (an error of execution), the use of a wrong plan to achieve an aim (an error of planning), or a deviation from the process of care that may or may not cause harm to the patient,” the researchers originally wrote in 2015. 

Some of these errors can be explained by the doctors and nurses being overworked. Poor judgment due to a chronic lack of sleep accounts for 10 to 20 percent of the variance in medical performance, a previous study noted. The effects of rudeness, however, could account for more than 40 percent, according to Amir Erez, a University of Florida management professor.

It seems unbelievable that so many medical errors or such a decline in performance can be traced down to rudeness. ‘Scenes’ are a common occurrence in hospitals but most of us would think that doctors have grown a thick skin. Even if someone gave them a bad day, we like to think that doctors shake it off and carry on with their work as professionally as nothing happened. But that’s just wishful thinking.

“[Rudeness] is actually affecting the cognitive system, which directly affects your ability to perform,” Erez said. “That tells us something very interesting. 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.”

Erez and colleagues performed an experiment involving 39 neonatal intensive care unit teams from Israel, each made of two doctors and two nurses. Five different scenarios were simulated in which the teams had to treat infant medical mannequins for emergency situations like severe respiratory distress or hypovolemic shock.

The wildcard was an actress who played the baby’s mother and who was tasked with scolding some of the doctors and nurses. Those who experienced no rudeness acted as the control group.

The study concludes that rudeness significantly impacted performance with the scolded teams performing poorly compared to the control. In fact, those who were nagged by the rude behaviour performed worse in all 11 of the study’s measures, among them diagnosis accuracy, therapy plan or communication. The negative effects seem to last the entire day.

Such conclusions are partly unbelievable, partly distressing. I or you might be able to restrain ourselves and be more civil to hospital staff, but the same can’t be said about everyone. Luckily, there are some working solutions.

The American researchers selected some of the teams for “emotional management”. Some played a computer game that was meant to raise the participants’ sensitivity to anger and aggression — that’s pre-test. Other teams participated in a post-test intervention which consisted of the team members writing about their day from the rude mother’s perspective.

Strikingly, one of the procedures actually work. Erez and colleagues found no difference in performance between the teams that played the video game and the control groups that received no scolding. The post-test invention, however, actually made things worse, as reported in the journal Pediatrics.

“What is really concerning is that, at midday, these teams recognized the mother was rude to them,” Erez said. “But at the end of the day, they did not. So not only did it not work, but it caused them to not recognize rudeness later.”

According to the researchers teaching doctors and nurses how to handle rudeness should be a priority given a large number of deaths attributed to medical errors.

“In the medical field, I don’t think they take into account how social interactions affect them,” said Erez, “but it’s something they’re starting to pay attention to. The purpose of this research was to identify what’s going on here. Now that we’ve found serious effects, we need to find more realistic interventions.”