Risk Alert: Being rude to colleagues threatens patient safety

27 January 2011

Rudeness and a lack of mutual respect among clinical teams can compromise patient safety and add to the risk of complaints and potential litigation.

An editorial published last year in the BMJ cited research results from a 2007 survey of 391 NHS operating theatre staff, in which two-thirds (66%) of respondents said they had been subject to aggressive behaviour from nurses and more than half (53%) from surgeons during the previous six months.

The editorial by Rhona Flin, professor of applied psychology at the University of Aberdeen, goes on to report that other research has shown that, as well as causing upset among colleagues, incivility can affect patient safety. Indeed the author observes that "a series of studies has shown that being the victim of rudeness can impair cognitive skills".

She cites an incident in 2009 when two Northwest Airlines pilots flying an Airbus A320 full of passengers from San Diego to Minneapolis began arguing over airline policy and lost "situational awareness" overshooting the airport by 150 miles before realising their error. The airline suspended both pilots and their licences were revoked. Professor Flin comments: "Whatever caused their lack of attention, the story illustrates the interplay between emotionally charged behaviour, namely arguing or rudeness, and cognitive skills, such as concentration."

The application of this example to the practice of medicine or dentistry is obvious. Rudeness or an emotionally charged atmosphere can distract medical or dental teams and draw their attention away from crucial tasks leading to potentially serious errors. This is a particular issue in confined spaces such as operating theatres or dental surgeries.

Dr John Holden, a senior medical adviser at MDDUS says:

"Doctors might not realise that something as basic as being rude to a colleague could ultimately harm the care of a patient. But they must at all times be mindful of the overriding duty of a doctor – as expressed by the GMC – to make the care of their patients their first concern. Consequently, any circumstance that may impair that duty – such as a poor relation with a colleague – is to be avoided."

The GMC requires that doctors must:

• Respect the skills and contributions of their colleagues.
• Communicate effectively with doctors within and outside the team.
• Make sure that colleagues (as well as patients) understand their role and responsibilities in the team.
• Support colleagues who have problems with performance, conduct or health.
• Treat colleagues fairly and with respect, avoiding bullying, harassment or unfair discrimination, taking care not to make malicious and unfounded criticisms of colleagues that may undermine patients’ trust in the care or treatment patients receive or in the judgement of those treating the patients.

Dr Holden adds: "Doctors should always strive to maintain good relationships with colleagues, and not simply as a means to patient safety but as a fundamental matter of good medical practice. This duty includes acting as a positive role model with commitment to motivating and inspiring colleagues."

The GDC holds similar values, as expressed in its Standards for dental professionals, requiring dentists to:

• Co-operate with other team members and colleagues and respect their role in caring for patients.
• Treat all team members and other colleagues fairly and in line with the law. Do not discriminate against them.
• Communicate effectively and share your knowledge and skills with other team members and colleagues as necessary in the interests of patients. In all dealings with other team members and colleagues, make the interests of patients your first priority.

A lack of respect displayed by rudeness or aggressive behaviour undermines all these principles and could lead to complaints and possible charges of impaired fitness to practise, not to mention potential errors with serious professional and legal consequences.

ACTION Consider the effects of rudeness and incivility among medical and dental colleagues and keep it out of your everyday practice.