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The Effects of Rudeness on Patient Care

Following the Golden Rule: The Impact of Rudeness in the Medical Office

Ah yes, the Golden Rule, If you can’t say something nice… Most of us associate this statement with our mothers beckoning us to play well with others and mind our manners. Bet mom didn’t know her advice actually had “life or death” implications.

The Effects of a “Rude” Physician

A recent study entitled, “The Impact of Rudeness on Medical Team Performance: A Randomized Trial,” showed that a rude comment from a third-party doctor decreased performance among doctors and nurses by more than 50 percent in an exercise involving hypothetical life or death situations. The study centered on a “rude” supervising physician and a neonatal intensive care team whose job was to treat a preterm infant with a rapidly deteriorating condition. The outcome was significant underperformance of the team to the detriment of the patient.

In addition, the study also found that rudeness:

  • Had adverse consequences on the performance of the team
  • Damaged the ability to think, manage information and make decisions
  • Inhibited communication amongst team members
  • Created an inability to function properly in complex situations which, in turn, hurt the patients

While a typical day in a medical practice may not routinely deal with life or death situations, the performance of the team and their ability to think, make decisions, communicate and function properly is essential to the success of the practice and overall satisfaction of the patient.

Becoming a Patient Friendly Practice defines rude as offensively impolite or ill-mannered. One can surmise that rudeness is really about perception; direct speech to some may be considered rude by others. The aforementioned study showed there was a palpable difference in the functionality of the team when the doctor was perceived as rude, but did the doctor see himself in the same light? Did he see his behavior as rude or as providing direct, concise orders to his team in a critical situation with no time for social etiquette? The biggest question is: Does it really matter?

True patient-centric practices understand the importance of the patient having an exceptional experience at every touch point. The quality of care as well as the quality of the experience is what drives our business, makes us leaders in our industry and keeps the competition at bay. The interaction between the most powerful individuals in the practice and the staff sets the tone for the culture and what is considered acceptable behavior. Certainly, disruptive or rude behavior is not limited to physicians. However, the power of the position wields greater impact on the staff and the consequences of the behavior are often far-reaching and everlasting. Conversely, positive comments and using errors as constructive teaching moments have the same level of power behind them.

Building the patient experience starts with the culture of the practice. Culture is illustrated by the acceptable norms and values of the individuals at every level. It is about the relationships and the way in which we regard and behave toward each other. Often the goals – the visions of how it should be and the reality of the culture that has evolved – are unrecognizable to one another. Is our daily behavior and the relationships we have with one another reflective of what the culture was supposed to be? Has it become acceptable to be “rude” to co-workers and subordinates? Do we think about how we are perceived as we go through our day or just make excuses that we are busy and don’t have time for basic courtesies?

Do Employees Work For You or With You?

If employees perceive physicians and supervisors as being “rude” during the course of their relationship, the Study suggests there will be a breakdown in communication, thought process and execution of tasks. This type of breakdown manifests itself in daily patient flow, be it:

  • Lack of attention to detail at registration
  • Not aggressively following up on insurance claims
  • Mislabeling a specimen
  • Not returning patient calls quickly
  • Etc…

Obviously, this will affect the workflow, patient care, interpersonal relationships and overall morale of the group. Morale issues in any business tend to divide the staff into two distinct categories: those that work for you and those that work with you.

The employees that work for you are the clock punchers; they will do enough to fly under the radar, get just enough of the job done not to warrant termination. They will be the first ones to leave each night and whatever gets done in the course of the day gets done. They will never leave a sick or vacation day on the table. In fact, they will probably take even more time than allotted without pay. These are not your go-to people and will never help you grow your practice.

The ones who work with you are the employees who feel valued, respected and empowered. They feel a responsibility to serve the practice and the patients, doing whatever is necessary even when it’s “not their job.” They are excited when things are going well and take it to heart when something doesn’t. They have a sense of ownership and bring ideas to improve the practice and feel pride in a job well done.

Employees who are satisfied with their work environments, the ones who want to work with you take ownership, will work harder and be proud of the contributions they make. This group will be high energy and willing to go the extra mile. At a very minimum, they can deliver a more positive perception of you and the services you provide.

The Link Between Staff Satisfaction and Patient Satisfaction

Numerous studies have been conducted on the correlation between staff satisfaction and patient satisfaction. In today’s demanding world, patient satisfaction is what drives business more than ever. Patients are more savvy when selecting a doctor for non-emergent issues. Long gone are the days when doctors were chosen only because of the list provided from their insurance company. Patients now take to the Internet to educate themselves on popular review websites, such as Healthgrades, Vitals and even Yelp. Reputation management has become a common concern for physicians and often employ professional marketing strategists to keep an eye on their reviews. Regardless of how reasonable or not reasonable the cause of a bad review might be, unsatisfied patients flock the Internet to express frustrations with a negative experience. Even when there was satisfaction with the doctor visit, patients are looking at their total experience and that includes making the appointment, the mood of the office, interaction with the checkout team, etc. Unhappy, unmotivated employees can make or break the patient experience and be the “difference makers” in current patients referring friends and family to the practice.

Implementing Structure for Your Practice

Rudeness in a medical setting and the consequences that follow it are, indeed, controllable. On a very basic level, it is showing the staff the same respect that you expect them to bestow upon your patients. The extension of basic courtesies (Welcome!, How may I help you?, Thank you!, Have a nice evening!) should not be out of the vocabularies of physicians and supervisors.

There are certainly times when staff behavior requires intervention. However, the method in which it is delivered should be provided by an extension of the physician, such as an office manager. Preserving the relationship with the staff member should be of paramount importance. Strong office managers will be able to address the issue in a factual way, creating appropriate documentation and communicating an understanding of consequences should that behavior continue. Losing control, snide remarks or berating a staff member only proves to undermine the goals of the day and begins the unraveling of the practice.

Implementing structure to keep the practice culture on the right track can be very helpful, especially as the practice grows. Creating codes of conduct for all staff, including physicians, often alleviates the difficult situations whereby one physician must address behavioral concerns with a counterpart. Using the word “perception” when describing how a conversation or attitude can negatively affect the team is a great way to diffuse any denying or brushing off of the concern. Perception is reality to the person who was offended by the interaction, it’s not about the intention of the conversation. Enforcing behavioral guidelines in a code of conduct ensures that any action taken later is not seen as “personal” or unwarranted by the disruptor because it has already been set out in the arrangement.

Everyone is responsible for their interactions throughout the day. However, the leaders of the practice guide the behavior, set the tone and control the culture. Mom was right; everyone does play better when you say something nice.