Rudeness Ruins Our Health

How impolite behavior affects cognitive function

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F YOU VERY MUCH: Understanding the Culture of Rudeness—and What We Can Do About It by Danny Wallace is on sale February 6, 2018 from TarcherPerigee, an imprint of Penguin Random House.

Dr. Amir Erez is an expert in positivity and positive thinking. Or was, until he also became an expert in rudeness.

“This is kind of a strange story,” he tells me when we speak. “Until seven or eight years ago I was not interested in rudeness at all. But I had to give a talk at the University of Southern California on the power of being positive. There I met another researcher, called Christine Porath.”

I’ve also become a bit of a fan of hers. She’s the woman who made people come up with new ideas for how to use a brick.

“We had lunch together,” says Erez, “and she told me all about her research into rudeness and incivility, and I just told her that I didn’t believe in any of this research.”

“That was rude,” I say.

“Yes! I said it in a very rude manner.”

“So much for the power of being positive.”

“I told her, why would it have any effect? These small insults? It’s not violence, not aggression, just small incidents! And we’re good at ignoring these minor things. Because otherwise we would walk around all depressed all the time. So I told her, no, I don’t see much evidence for it.”

“You mean scientific evidence?”
“It’s all self-reported. People saying, ‘Oh, this happened,’ or ‘That happened,’ and they felt insulted and like it affected their performance and so on.”

Erez said the only way he’d believe that rudeness had an impact was if Porath could actually induce rudeness and measure the effects it had. She struck back, saying fine, if you don’t believe me, let’s do it together. Each simply wanted to prove the other wrong.

“So this was essentially the academic version of a drunken bet?” I ask.

“It was. It was pretty much a bet. And she was right and I was wrong. Since then we’ve conducted many studies, and the effects are just absolutely amazing. Each and every time I conduct a study, I don’t believe I will find much. But I always find something. And the effects of rudeness to me are astonishing.”

It’s astonishing, because what Erez found was that rudeness can kill.

“One of the reasons rudeness is so devastating is that it affects cognition. When people encounter rudeness they can’t think in the same way. We know now that it affects working memory.”

Working memory is important. It’s used in reasoning, in decision making, and in determining our behavior.

“That’s the part of the process where everything is happening. Planning, goal management, memory—pretty much everything is dependent on working memory.”

In one of their studies, the team looked at attention. They found that when people experience rudeness, they miss obvious information. “Even when it’s in the center of their visual field. So I said to one of my friends, ‘This is really scary. Can you imagine if this happened in surgery? Can you imagine if a surgeon was rude to an anesthesiologist, and the anesthesiologist now starts to miss information that’s right in the center of their visual field, for like 30 seconds?’”

And as the words sank in, they decided they had to test it.

“And we found that it has devastating effects,” he says, before pausing. “It is terrifying.”

• • •

The study, “The Impact of Rudeness on Medical Team Performance,” took place in Tel Aviv.

Erez and his colleagues gave 24 medical teams—each one comprised of one doctor and two nurses from neonatal intensive care units—one hour to diagnose and treat a sick baby.

It was all simulated, of course—and for the experiment they chose a case of something called necrotizing enterocolitis.

Put simply, that’s a potentially fatal disease that moves rapidly around a premature infant’s intestinal tissue. If it’s not treated immediately, it begins to inflame the tissue, which starts to die. So does the baby.

Before any of the teams got to work, they were told that a leading expert from the United States would be observing them through a webcam. In front of the teams, a researcher then rang a fake phone number and played a message from that “expert.”

Half the teams heard a perfectly normal message.

The other half heard this expert rudely inform them that he had observed other medical teams from their country and was “not impressed with the quality of medicine in Israel.”

The simulation began. The teams got to work. Ten minutes later, another message arrived.

Half the teams heard the expert say he hoped that the simulation would help them in their work.

The other half were told that based on their work so far, they “wouldn’t last a week” in his department.

So what happened?
The teams that experienced no rudeness did just fine.
The teams that experienced rudeness fell to pieces.

They had trouble communicating, they couldn’t work out how to cooperate, they forgot basic instructions, and they misdiagnosed the illness. The doctors asked for the wrong drugs. The nurses prepared the wrong things. They didn’t ventilate the patient in the way they should have, nor did they resuscitate well.

Three outside judges appraised the results, without knowing what the experiment was all about. The difference in the quality of their work was incredible. What Erez discovered is that even one rude comment in a high-pressure environment decreased perform- ance by doctors and nurses in a life-or-death situation by more than 50 percent.

The doctors who’d been treated rudely could well have killed their tiny patient as a result.

If you’re a little brusque with the man in the hospital sandwich shop, he might hand you a cheese and pickle sandwich instead of cheese and ham.

Be rude to a doctor, and you might never eat again.

Credit line: Reprinted from F You Very Much: Understanding the Culture of Rudeness—and What We Can Do About It by arrangement with TarcherPerigee, an imprint of Penguin Publishing Group, a division of Penguin Random House LLC. Copyright © 2018, Danny Wallace.

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