Kind can be hard, polite should be mandatory

IT isn’t always easy to be nice in medicine, but couldn’t we always try not to be rude?

A few weeks ago, Tom*, a doctor and close friend, was diagnosed with a serious illness. After months of ignoring a niggling cough, his chest x-ray showed a string of enlarged lymph nodes and he was sent for a computed tomography (CT) scan.

Not prone to worry, he didn’t really. But, like the lymph nodes, he couldn’t shrink the anxiety that nestled in his chest as he presented for the scan.

At the radiology clinic he glimpsed the world of being a patient.

“The interactions were either cold or rude – really transactional,” he told me.

At the desk, the receptionist snapped at him to fill out a form somewhere else, then he was ushered to the scanning bed, where the rushed technician told him to hold still and listen for the machine. So Tom lay still and listened for the machine.

“Breathe!” it growled. And so he did. “Hold your breath!” it growled again.

“Hold my breath in, or out?” thought Tom, not wanting to make a mistake.

At that point the technician came back in, clearly annoyed. He told Tom they were already running late and to take a deep breath in and hold it. Chastised, Tom did as he was told.

Afterwards, back in the waiting room, Tom asked if he could see the radiologist to discuss his scan. After 20 minutes, she came out to the waiting room.

“And, then she told me, without introducing herself, ‘I can’t be sure what it is but either way, you’re going to need chemotherapy’. It really floored me,” he said.

“Mostly, though, I was just embarrassed that everyone in the waiting room had seen and heard it.”

But it might be more than just hurt feelings at stake.

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A recent study in Pediatrics showed that clinical performance decreased significantly for neonatal intensive care teams as they tried to complete their tasks in the face of rudeness. There is now a randomised controlled trial proving that we don’t perform as well if we’re rude to each other.

How surprising.

Having said that, in preparing for this article, I couldn’t find any trials that proved there was a worse outcome for our patients if we were rude to them.

Do we really need one?

In a paper published in the Journal of Advanced Nursing in 2010, it was reported that up to two-thirds of operating theatre staff have seen rude behaviours and half of them have been in the firing line.

It seems too that rudeness might be contagious – or at least can be described like a contagion. Perhaps that explains why some workplaces just seem ruder than others.

There are, of course, lots of reasons why health care workers might be rude. From burnout to simply running out of time – ours is a world of rapid consultations and workforce pressures to do more with less.

There’s no doubt that we have to develop a thick skin early on, weathering the job of treating sickness in uncertainty and inadequacy. Perhaps impatience or rudeness can be explained, but not excused, by the stress we often endure. It’s easy to see how, in the milieu of patient problems, we can lose sight of our patients.

Maybe it makes it easier because most of what we have to offer to patients actually works – and is often free. And so our patients forgive us for being a bit prickly from time to time.

Whatever the reasons for rudeness, it wasn’t much fun for Tom. After his experience, feeling drained, he left the radiology suite and decided to have a massage to try to relax.

The masseur welcomed him warmly, put her hand on his chest and said she could see his stress and wanted to heal him – generic but sincere words of human connection.

“I nearly burst into tears,” he said.

Ironically, Tom might end up owing his life to the information in the CT scan that day and to the expertise within the radiology clinic. But they’re not the ones who actually cared for him.

*Not his real name. Story used with Tom’s permission.

Dr Simon Hendel is a Melbourne-based anaesthetist and is completing his postgraduate studies in journalism.