Journal Article | Others

September 24, 2021

Arieh Riskin, MD, MHA, Amir Erez, PhD, Trevor A. Foulk, BBA, Amir Kugelman, MD, Ayala Gover, MD, Irit Shoris, RN, BA, Kinneret S. Riskine, and, Peter A. Bamberger, PhD



Iatrogenesis is an adverse condition resulting from medical treatment. It includes errors from diagnosis to treatment as well as failure to identify and respond to these errors. It causes significant morbidity or mortality.


Iatrogenesis is often linked to patient-related factors such as age, with critically ill pediatric patients at higher risk. However, practitioner stressors such as incivility or rudeness can also lead to the same outcome. Although preventable, the lack of research on other causes of iatrogenesis poses a challenge to its management.




Owing to the high-intensity and service-oriented nature of their profession, health care workers often experience rudeness which is a mild form of aggression or incivility. This affects the cognitive and communication skills of medical practitioners, leading to iatrogenic events.


There are three main kinds of rudeness experienced by healthcare workers. Hierarchical rudeness comes from senior officers while those from colleagues and members of the medical team are termed peer rudeness. The third kind is termed and is from client rudeness.


A 2015 study by Riskin et al. confirms the effect of rudeness on health care professionals and provides opportunities for prevention of iatrogenic events.




 The study aims to determine the effect of rudeness on the performance of medical teams, specifically their diagnostic and procedural performance and their information sharing and help-seeking behaviors.




This study is a double-blind, randomized clinical trial. Seventy-two neonatal intensive care unit (NICU) professionals were randomized into two teams. Both teams were shown an initial video by an ICU expert on how reflexivity can enhance team performance.


The second phase of the trial involved a simulation where a NICU case was presented and some level of diagnosis had to be made. After which, those from the control team received a video from the ICU expert giving neutral comments. This video was manipulated for the experimental team where negative comments on their performance as well as an insult were given by the expert.



The last phase of the trial is a demonstration of procedural skills on the management of a different NICU case. A panel of physicians evaluated the teams based on written outputs and videos of their performance.


Multivariate analysis revealed that rudeness was responsible for the significant 12% variation in diagnostic and procedural performance between the teams with the experimental team having lower performances. Likewise, there is a significant decrease in their information-sharing and help-seeking behaviors.


Integrating all these in a model, rudeness has been shown to decrease diagnostic performance by reducing information-sharing among members of the medical team. Helping team members was also decreased by rudeness, negatively affecting their procedural performance.




Acts of rudeness disrupt the performance of the medical team and the collaborative processes that can overcome errors, increasing the risk for iatrogenic events.



Riskin, A. et al. The Impact of Rudeness on Medical Team Performance: A Randomized Trial. Pediatrics. 2015.

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