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Nobody likes being belittled or even being on the receiving end of some mild sarcasm or low level impoliteness. But does it actually make a difference to anything?
After all, many of us have been brought up with the mantra that sticks and stones may break our bones, but words will never harm me, so why should we really care if a colleague (probably a senior one) is having a bad day and taking it out on us?
According to Chris Turner, it matters a heck of a lot. Speaking at the BMA’s Scottish Conference in Glasgow in September, he made a very strong case for civility saving lives – and conversely, that incivility can be hugely harmful. This harm extends not just to the person who is the direct victim of the rudeness, but also to those who witness it; ultimately, it also has a detrimental effect on patient care.
The theme of the conference was ‘Doctors under Pressure’, but it also showcased the support available to medics fighting to cope with increasing demands in an increasingly challenging working environment. Professor Dame Parveen Kumar set the scene for the more than 200 doctors and medical students who attended the day-long event by laying bare the extent to which medicine succeeds at doctors’ expense.
She spoke about burnout, about suicides among doctors, about stress, anxiety and ill-health, and about the expectation that medics would keep going at all costs – even if that cost proved to be their own health and lives. The talk resonated with the audience – one person said to me at lunchtime that it was as though she had been talking about him and his life, and he wasn’t alone in that.
One of the big messages that came through from Dame Parveen’s talk was that changing working practices had left doctors feeling more isolated and under pressure than ever before. She wasn’t just talking about rising workloads and patients with increasingly complex needs, although obviously theses are important factors. She was also making the case that shift systems means that doctors did not have ‘constant colleagues’. The old ‘firm’ system of hospital working had its benefits, she said, not least that after a gruelling shift, the team could go to the pub together to talk things through and decompress. The lack of ‘mess’ provision and communal dining for doctors also contributed to this sense of isolation, she added.
Dame Parveen, who is chair of the BMA Board of Science, and a former BMA president, said she hoped she hadn’t ‘depressed’ the audience, but she did warn that the profile of doctors seeking support from the likes of the Royal Medical Benevolent Fund was changing. The fund, which offers financial support to doctors and medical students in need, has noticed that the age of applicants is falling as the pressures start to bite when people are at an earlier stage in their careers. Dame Parveen called this tragic.
Dr Turner, a consultant in emergency medicine at University Hospitals of Coventry and Warwickshire, offered a possible way forward. As one founder of the Civility Saves Lives campaign, he is determined to raise awareness of the impact that people working in healthcare can have on each other.
He cited evidence that rudeness can have a hugely detrimental impact on performance. For example, one experiment (in a simulated scenario) showed that anaesthetists exposed to mildly rude statements (that had nothing to do with the matter at hand) were much less likely to perform at the expected level than those who had been treated with politeness. Importantly, when asked about it afterwards, those who had been exposed to rudeness did not think it had affected them in the slightest, although it clearly had.
The impact is spread widely. Research has shown that while 80 per cent of recipients of rudeness lose time worrying about it, and 38 per cent reduce the quality of their work, there is a 20 per cent decrease in the performance of staff who witness it. Onlookers are also half as likely to be willing to help others as a result of seeing the rudeness.
Importantly, this isn’t about blowing a full-blown tantrum of obnoxiousness. ‘It’s mild to moderate rudeness – being “a bit not nice”,’ Dr Turner said, adding that we could all do with examining whether we are at fault in how we deal with colleagues.
There is hope, however. He compared the insight that incivility costs lives to the discovery that smoking kills – if we take the opportunity to banish rudeness from the workplace, the impact could be amazing.