Rudeness in healthcare: The deadly fixation that could cost lives

According to groundbreaking research from the University of Maryland, incidental rudeness can prove deadly in healthcare. Termed “anchoring bias,” fixation on minor details during critical decision-making processes can have fatal consequences, particularly within hospitals. Lead researcher Trevor Foulk warns that doctors’ fixation on preliminary diagnoses influenced by rudeness can lead to misdiagnoses and inappropriate treatments. In simulations involving 138 anesthesiology residents, rudeness increased mortality rates, emphasising the urgency for awareness and intervention. The study underscores the need for a respectful culture in medical settings, where split-second decisions have life-or-death implications. The article was first published on FirstRand Perspectives.

How rudeness leads to Anchoring in life and death situations

By Adrian Ephraim

We’ve seen it all too often. A rush of blood to the head, a moment of insanity, an “emotional” decision taken through the spoken word, or an action that can never be taken back.

Often, it is a reaction to someone’s lack of courtesy, outright rudeness, or worse. It’s called anchoring bias when we obsess about the rude encounter and allow it to colour our decision-making process.

Now, researchers in the United States have revealed how incidental rudeness can influence our decision-making, which sometimes turns deadly.

The “anchoring bias” happens when we fixate on a minor detail when making an important decision, clouding our judgment in critical situations. Those situations often play out in hospitals, where anchoring can play a pivotal role in how a doctor diagnoses a patient, according to experts

Research co-authored by management professor Trevor Foulk at the University of Maryland’s Robert H. Smith School of Business, titled “Trapped by A First Hypothesis: How Rudeness Leads to Anchoring“, shows that in certain situations, rudeness of minor consequence can end up being deadly.

“If you go into the doctor and say, ‘I think I’m having a heart attack’, that can become an anchor, and the doctor may get fixated on that diagnosis, even if you’re just having indigestion,” Foulk stated. “If doctors don’t move off anchors enough, they’ll start treating the wrong thing.”

In the report, Foulk and his co-authors Binyamin Cooper of Carnegie Mellon University, Christopher R. Giordano and Amir Erez of the University of Florida, Heather Reed of Envision Physician Services, and Kent B. Berg of Thomas Jefferson University Hospital researched how rudeness amplifies the anchoring bias.

Having studied rudeness for years, Foulk knew that when people experience rudeness, it “takes up a lot of their psychological resources and narrows their mindset”. This, they believe, plays a role in the anchoring bias. “In simulations, we’re finding that mortality is increased by rudeness. People could be dying because somebody insulted the surgeon before they started operating,” Foulk says.

The team conducted medical simulations with anesthesiology residents at an American university as part of the research. A total of 138 medical students participated. Participants were randomly split equally into either a rudeness or control condition. The students were required to diagnose and treat the patient; however, before the treatment started, students were given a false diagnosis.

“Participants were told they would assume the role of Leslie Wilder, MD (a gender-neutral name), a physician at the hospital’s Emergency Department (ED),” the study says. “They were further told that as physicians who work in the hospital’s ED, they would see patients with a variety of conditions, ranging from patients with emergent conditions, such as strokes and injuries from car accidents.”

To make the simulation more realistic, participants were asked to listen to typical conversations in the emergency department. “They listened to a recording of an interaction between an attending emergency medicine physician named Bill, whom they were tasked with shadowing that day, and another senior emergency medical physician (who was not Bill’s direct supervisor),” the study explains.

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