A med­ical en­vi­ron­ment with re­spect­ful staff is a safer one.

Hav­ing a bad day at work can hap­pen to any­one, any­where, at any time.

How­ev­er, if you are a doc­tor, a bad day at work could put some­one’s life at risk.

Whether it’s be­ing pre-oc­cu­pied by non-work is­sues or hav­ing to face more than your share of dai­ly work chal­lenges, how you re­spond to a dif­fi­cult sit­u­a­tion can, in fact, de­ter­mine your pa­tient’s out­come.

As a con­sul­tant, I have had mo­ments when events have prompt­ed my re­ac­tion to vary from mild ir­ri­ta­tion and an­noy­ance to out­right in­fu­ri­a­tion and anger. Med­ical stu­dents, ju­nior doc­tors, mid­wives, nurs­es, oth­er hos­pi­tal staff—I have had ex­pe­ri­ences with all of them when it is vir­tu­al­ly im­pos­si­ble to keep cool un­der pres­sure.

Nev­er­the­less, there is a pro­fes­sion­al re­spon­si­bil­i­ty not to rise to provo­ca­tion, no mat­ter how dif­fi­cult that may be, and to ex­ert self-con­trol to get the best out of a tricky sit­u­a­tion for the pa­tient’s ben­e­fit. Af­ter all, mis­takes in hos­pi­tals can have grave con­se­quences, and ul­ti­mate­ly, I am re­spon­si­ble for my pa­tients’ well-be­ing.

In Trinidad and To­ba­go, if you have been in a med­ical in­sti­tu­tion, whether you were a mem­ber of staff, a stu­dent, a doc­tor, a nurse or a pa­tient or even a vis­i­tor, you may have at some point no­ticed be­hav­iour that could be con­sid­ered to be rude, in­sult­ing, boor­ish or just down­right un­friend­ly and un­help­ful. Whether it hap­pens be­tween staff mem­bers, se­niors and ju­niors or doc­tor and pa­tient, it is bound to make you feel un­com­fort­able and un­easy.

Oth­er than just the un­pleas­ant­ness of it all, the im­pact of un­civ­il be­hav­iour on every­one around is what is most dis­tress­ing and can, in fact, lead to un­der­per­for­mance which then equates to poor health care.

There is now re­search to back this up.

For in­stance, a se­nior doc­tor who rep­ri­mands their ju­nior coun­ter­part in a dis­re­spect­ful way, re­sults in a 61 per cent re­duc­tion in cog­ni­tive abil­i­ty in the ju­nior doc­tor as well as 38 per cent re­duc­tion in their qual­i­ty of work and a 48 per cent re­duc­tion in their time at work.

For staff by­standers who wit­ness any form of rude be­hav­iour, this may al­so re­sult in a 20 per cent de­crease in their per­for­mance and a 50 per cent de­crease in their will­ing­ness to help oth­ers while they are al­so 50 per cent more like­ly to miss an er­ror in cal­cu­la­tions. In ad­di­tion, ju­nior staff are less like­ly to call for help if they feel that they will be chas­tised or rep­ri­mand­ed.

All of this adds up to less ef­fec­tive pa­tient care and more like­li­hood for mis­takes.

Cru­cial­ly, the view from the hos­pi­tal bed is al­so not rosy.

Pa­tients who are in­volved in such sit­u­a­tions with seem­ing­ly un­sym­pa­thet­ic or un­help­ful staff or in­deed wit­ness rude be­hav­iour feel in­tim­i­dat­ed and ap­pre­hen­sive and are of­ten too scared to ask for help.

On the oth­er side of the coin, in­ap­pro­pri­ate be­hav­iour from pa­tients’ rel­a­tives has been proven to wors­en the health­care team’s per­for­mance with re­sul­tant ad­verse ef­fects on nec­es­sary in­ter­ven­tions.

Even for sur­gi­cal pro­ce­dures, stud­ies have shown that non-tech­ni­cal skills are just as im­por­tant as prac­ti­cal sur­gi­cal skills, but in the field of med­i­cine, these are woe­ful­ly ne­glect­ed. In safe­ty-crit­i­cal in­dus­tries such as the avi­a­tion in­dus­try, pi­lots are trained and in­di­vid­u­al­ly as­sessed on skills such as team-com­mu­ni­ca­tion, stress and risk tol­er­ance, high-speed de­ci­sion mak­ing and ef­fects of fa­tigue on crew er­ror. No doubt, the sur­gi­cal abil­i­ty to do a Cae­sare­an sec­tion is es­sen­tial, but good com­mu­ni­ca­tion, mak­ing cru­cial de­ci­sions, and be­ing re­spect­ful and civ­il to all team mem­bers is not op­tion­al.

Un­civ­il be­hav­iour in a hos­pi­tal set­ting is not unique to us here in T&T and in the UK, there is cur­rent­ly an on­go­ing cam­paign of “Ci­vil­i­ty Saves Lives” that aims to high­light this is­sue. They em­pha­sise what we may con­sid­er to be com­mon sense, but it does need to be said all the same.

When we per­mit rude­ness, pa­tients suf­fer un­nec­es­sar­i­ly, but cre­at­ing a cul­ture of re­spect and kind­ness im­proves con­fi­dence, com­pe­tence and can on­ly ben­e­fit all in­volved.