Tag Archives: pedestrians

Rudeness: A Rude Awakening

Rudeness seems to be on the rise.  Why?

Being rude rarely makes anyone feel better.  I’ve often wondered why people in professions where they meet the public, like servers in a restaurant, decide to act rudely, when greeting the public with a more cheerful demeanor probably would make everyone feel better.

Pressure undoubtedly plays a huge role.  Pressure to perform at work and pressure to get everywhere as fast as possible.  Pressure can create a high degree of stress–the kind of stress that leads to unfortunate results.

Let’s be specific about “getting everywhere.”  I blame a lot of rude behavior on the incessantly increasing traffic many of us are forced to confront.  It makes life difficult, even scary, for pedestrians as well as drivers.

How many times have you, as a pedestrian in a crosswalk, been nearly swiped by the car of a driver turning way too fast?

How many times have you, as a driver, been cut off by arrogant drivers who aggressively push their way in front of your car, often violating the rules of the road?  The extreme end of this spectrum:  “road rage.”

All of these instances of rudeness can, and sometimes do, lead to fatal consequences.  But I just came across several studies documenting far more worrisome results from rude behavior:  serious errors made by doctors and nurses as a result of rudeness.

The medical profession is apparently concerned about rude behavior within its ranks, and conducting these studies reflects that concern.

One of the studies was reported on April 12 in The Wall Street Journal, which concluded that “rudeness [by physicians and nurses] can cost lives.”  In this simulated-crisis study, researchers in Israel analyzed 24 teams of physicians and nurses who were providing neonatal intensive care.  In a training exercise to diagnose and treat a very sick premature newborn, one team would hear a statement by an American MD who was observing them that he was “not impressed with the quality of medicine in Israel” and that Israeli medical staff “wouldn’t last a week” in his department. The other teams received neutral comments about their work.

Result?  The teams exposed to incivility made significantly more errors in diagnosis and treatment.  The members of these teams collaborated and communicated with each other less, and that led to their inferior performance.

The professor of medicine at UCSF who reviewed this study for The Journal, Dr. Gurpreet Dhallwal, asked himself:  How can snide comments sabotage experienced clinicians?  The answer offered by the authors of the study:  Rudeness interferes with working memory, the part of the cognitive system where “most planning, analysis and management” takes place.

So, as Dr. Dhallwal notes, being “tough” in this kind of situation “sounds great, but it isn’t the psychological reality—even for those who think they are immune” to criticism.  “The cloud of negativity will sap resources in their subconscious, even if their self-affirming conscious mind tells them otherwise.”

According to a researcher in the Israeli study, many of the physicians weren’t even aware that someone had been rude.  “It was very mild incivility that people experience all the time in every workplace.”  But the result was that “cognitive resources” were drawn away from what they needed to focus on.

There’s even more evidence of the damage rudeness can cause.  Dr. Perri Klass, who writes a column on health care for The New York Times, has recently reviewed studies of rudeness in a medical setting.  Dr. Klass, a well-known pediatrician and writer, looked at what happened to medical teams when parents of sick children were rude to doctors.  This study, which also used simulated patient-emergencies, found that doctors and nurses (also working in teams in a neonatal ICU) were less effective–in teamwork, communication, and diagnostic and technical skills–after an actor playing a parent made a rude remark.

In this study, the “mother” said, “I knew we should have gone to a better hospital where they don’t practice Third World medicine.”  Klass noted that even this “mild unpleasantness” was enough to affect the doctors’ and nurses’ medical skills.

Klass was bothered by these results because even though she had always known that parents are sometimes rude, and that rudeness can be upsetting, she didn’t think that “it would actually affect my medical skills or decision making.”  But in light of these two studies, she had to question whether her own skills and decisions may have been affected by rudeness.

She noted still other studies of rudeness.  In a 2015 British study, “rude, dismissive and aggressive communication” between doctors affected 31 percent of them.  And studies of rudeness toward medical students by attending physicians, residents, and nurses also appeared to be a frequent problem.  Her wise conclusion:  “In almost any setting, rudeness… [tends] to beget rudeness.”  In a medical setting, it also “gets in the way of healing.”

Summing up:  Rudeness is out there in every part of our lives, and I think we’d all agree that rudeness is annoying.  But it’s too easy to view it as merely annoying.  Research shows that it can lead to serious errors in judgment.

In a medical setting, on a busy highway, even on city streets, it can cost lives.

We all need to find ways to reduce the stress in our daily lives.  Less stress equals less rudeness equals fewer errors in judgment that cost lives.

You wouldn’t like me when I’m angry

We see anger all around us. And it’s worse than ever. As The New York Times recently noted, rudeness and bad behavior “have grown over the last decades.” The Times focused on rudeness and incivility by “mean bosses” who cause stress in the workplace, but the phenomenon is widespread, appearing almost everywhere.

Along with mean bosses, we’ve all witnessed incidents of “road rage.” These sometimes lead to fatal results. I can understand road rage because I’m susceptible to it myself, but I strive to keep it under control. (I’m usually satisfied by hurling vicious insults at other drivers that they fortunately can’t hear.)

As a pedestrian, I’m often angered by rude and careless drivers who nearly mow me down as I walk through a crosswalk. Fortunately, my rage is usually tempered by my silent riposte, “I’m walkin’ here,” Ratso Rizzo’s enduring phrase.

Other common examples of anger include parents’ frustration with their children’s behavior. You’ve probably seen parents going so far as to hit their children in public, unable to restrain their anger even when others are watching.

Can we deal with anger by seeking revenge? That tactic, unwisely adopted by the two enraged drivers in the Argentinian film “Wild Tales,” may be tempting, but it’s clearly not the answer. Why? Because being angry simply isn’t good for your health.

Although anger can be useful—helping the body prepare to fight or flee from danger–strong anger releases hormones, adrenaline and cortisol, into the bloodstream. These can trigger an increase in heart rate and blood pressure and problems metabolizing sugar (leading to still other problems).

According to the Times article, Robert M. Sapolsky, a Stanford professor and author of “Why Zebras Don’t Get Ulcers,” argues that when people experience even intermittent stressors like incivility for too long or too often, their immune systems pay the price. Major health problems, including cardiovascular disease, cancer, diabetes, and ulcers may result.

A host of medical researchers are not at all upset to tell you the results of their studies. “Anger is bad for just about everything we have going on physically,” according to Duke researcher Redford Williams, co-author of “Anger Kills: Seventeen Strategies for Controlling the Hostility That Can Harm Your Health.” Over time, he adds, chronic anger can cause long-term damage to the heart.

For example, new evidence suggests that people increase their risk for a heart attack more than eight times after an extremely angry episode. A study published in March 2015 revealed that patients who’d experienced intense anger had an 8.5 times greater risk of suffering a heart attack in the two hours after an outburst of intense anger than they would normally.

The study, published in the European Heart Journal: Acute Cardiovascular Care, focused on patients in a Sydney, Australia, hospital who’d been “very angry, body tense, maybe fists clenched, ready to burst,” or “enraged, out of control, throwing objects, hurting [themselves] or others.” Although those are instances of extreme anger, not a typical angry episode, the finding is useful nonetheless.

A review of nine other studies, including a combined 6,400 patients, found a higher rate of problems like strokes as well as heart attacks and irregular heartbeat.

According to a recent article in The Wall Street Journal, most doctors believe smoking and obesity pose greater heart risks than anger does. But someone with risk factors for heart trouble or a history of heart attack or stroke who is “frequently angry” has “a much higher absolute excess risk accumulated over time,” according to Elizabeth Mostofsky at Boston’s Beth Israel Deaconess Medical Center, who help lead the nine-study review.

As the Journal article noted, some older studies have suggested that anger may be linked to other unfavorable results: increased alcohol consumption, increased smoking, and greater caloric intake. One study also found that high levels of anger were associated with serious sleep disturbances.

How do we deal with all of this anger? Anger-management counselors like Joe Pereira, cited by the Journal, recommend ways to curb hostility. First, avoid assuming others are deliberately trying to harm or annoy you. Also learn to tolerate unfairness, and avoid having rigid rules about how others should behave. “The more rules we have, the more people are going to break them. And that makes us angry,” Pereira says.

Experts also advise taking a timeout when one is gripped by anger. Karina Davidson, director of the Center for Behavioral Cardiovascular Health at Columbia University Medical Center, advises those who are prone to shouting to tell others “I’m very [hotheaded and] say things that don’t help the situation. It would help me if I could have 10 minutes and then maybe we could work together to resolve the situation.”

Lawyers are people who deal with anger all the time. As long ago as ancient Rome, the poet Horace wrote that lawyers are “men who hire out their words and anger.” Today, lawyers not only confront angry clients but also have to manage anger stemming from their opponents and themselves.

An article in the June 2014 issue of California Lawyer noted that lawyers currently face “an epidemic of incivility contaminating…the profession.” The authors, Boston lawyer Russell E. Haddleton and Joseph A. Shrand , M.D. (author of “Outsmarting Anger”), noted that the California Supreme Court had just approved a revised oath of admission requiring that new lawyers commit to conducting themselves “at all times with dignity, courtesy, and integrity.”

Acknowledging that incivility will continue to crop up, the authors maintain that an angry lawyer is an ineffective advocate. They suggest a number of things lawyers can do to stay calm. Tips like these can help all of us.

Among their suggestions: Begin by recognizing the physical signs of anger, and think of ways to change the situation. Next, try to avoid being jealous of a talented adversary. Jealousy can cloud one’s vision and ignite anger. Finally, to defuse anger “in yourself, your opponent, the judge, jurors, or a witness,” they advise lawyers to aim for a calm demeanor that displays empathy, communicates clearly, and above all, shows respect for others.

“Respect” is the key watchword here. The authors argue that it gives lawyers an advantage by allowing them to use reason and common sense instead of rashly reacting to what goes on in a courtroom. Lawyers who reject angry responses and choose a respectful approach are better advocates. This approach can clearly help non-lawyers as well.

In the current Pixar film, “Inside Out,” an 11-year-old girl struggles with her emotions. The emotion of Anger (voiced by Lewis Black) sometimes tries to dominate, but the emotion of Joy (voiced by Amy Poehler) seeks to keep it under control, not letting it take over. This may be the answer for all of us. If we try to find the joy in our lives—the good things that make us happy–we can triumph over anger and all of the dangerous consequences that flow from it.

We don’t have to turn into a large green Hulk every time something angers us. Let’s try instead to emulate the non-angry side of the Hulk.

I plan to do just that. You’ll like me much better that way.