July 22, 2011
Rudeness and incivility among doctors, in particular in the operating room, can actually lead to poorer health outcomes and even higher death rates among patients.
Dr. Andrew Klein, director of comprehensive transplant center at Cedars Sinai in Los Angeles, and his colleague Pier Forni, founder of the Johns Hopkins Civility Project at Johns Hopkins University, collected data on previous studies of surgeons' behavior in the operating room and the subsequent outcomes of the patients on whom they performed procedures. They found that when doctors were more courteous to operating room staff, their patients were more likely to survive and avoid complications than the patients of docs who were O.R. boors.
And the legacy of incivility didn't stop in the operating arena. In studies of medication orders at hospital pharmacies, the researchers found that 75% of pharmacists and nurses prefer not to confront difficult physicians to ask about potential medication interactions or errors in the prescription. If a doctor who may be making a prescribing mistake goes unchallenged, patients may wind up getting the wrong type or amount of drug — with potentially disastrous consequences.
But it's the O.R. where manners are worst, and two particular features of the setting conspire to up the obnoxiousness ante. One is the stress of having a patient's life hang in the balance with every decision, and two, the anonymity of the surgical attire. “Everyone is wearing gowns, gloves, and masks, and it's a terrific camouflage,” says Klein, who as a surgeon admits to falling into the incivility trap. “Often you don't know the people you are working with, and you don't know their names. So if you ask for a clamp and what you get is a clip, the response in many cases is to throw the thing on the floor, maybe with an expletive, and say ‘I said clamp, not clip.' However, if you knew the person who had handed you the clip, or knew something about his or her family, you wouldn't act the same way.”