Tag Archives: UCSF

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.

Put some spice into your (longer) life

Do you like spicy food? I do! So I was happy to learn about the mounting evidence that eating spicy food is linked to a longer life.

The New York Times, CNN, and Time magazine recently reported on a Chinese study of nearly half a million people (487,375, to be exact). The mass of data collected in that study showed an association between eating spicy food and a reduced risk of death.

The study, reported in the medical journal BMJ, included Chinese men and women enrolled between 2004 and 2008 and followed for an average of more than seven years. Using self-reported questionnaires, the researchers analyzed the spicy food consumption of people aged 30 to 70 across 10 regions in China, excluding those with cancer, heart disease, and stroke. The researchers controlled for family medical history, age, education, diabetes, smoking, and a host of other variables.

They found that those eating spicy food, mainly food containing chili peppers, once or twice a week had a 10 percent reduced overall risk for death, compared with those eating spicy food less than once a week. Further, they found that consuming spicy food six to seven times a week reduced the risk even more–14 percent.

Spicy food eaters had lower rates of ischemic heart disease, respiratory diseases, and cancers. (Ischemic heart disease, a common cause of death, arises from a reduced blood supply to the heart, usually caused by atherosclerosis.)

Although the researchers drew no conclusions about cause and effect, they pointed out that capsaicin, the main ingredient in chili peppers, had been found in other studies to have antioxidant and anti-inflammatory effects.

“There is accumulating evidence from mostly experimental research to show the benefit of spices or their active components on human health,” said Lu Qi, an associate professor of nutrition at Harvard’s T. H. Chan School of Public Health and a co-author of the study. But, he added, “we need more evidence, especially from clinical trials, to further verify these findings, and we are looking forward to seeing data from other populations.”

What’s different about spicy foods? The study highlights the benefits of capsaicin, a bioactive ingredient in chili peppers, which has previously been linked to health perks like increased fat-burning.

But most experts emphasize the need for more research. One such expert is Daphne Miller, associate clinical professor at the University of California, San Francisco, and author of “The Jungle Effect: The Healthiest Diets from Around the World, Why They Work and How to Make Them Work for You.”

Miller told CNN that many variables associated with eating spicy food haven’t been addressed in the study. The study itself notes that it lacks information about other dietary and lifestyle habits and how the spicy food was cooked or prepared. “It’s an observational study within a single culture,” she said.

In addition, the researchers note that although chili pepper was the most commonly used spice, the use of other spices tends to increase as the use of chili pepper increases. Consuming these other spices may also result in health benefits.

But Miller said the findings are still plausible, given the fact that spicy foods also have high levels of phenolic content, which are chemicals with nutritional and anti-inflammatory values.

Bio-psychologist John E. Hayes agrees. Hayes, an associate professor of food science and director of the Sensory Evaluation Center at Penn State University, has previously studied spicy food and personality association. According to CNN, he notes that chili intake has an overall protective effect. But why? “Is it a biological mechanism or a behavioral mechanism?”

Eating spicy food might work biologically to increase the basil metabolic rate, says Hayes. But it might also slow food intake, causing a person to eat fewer calories.

Although Lu Qi believes the protective effect associated with spicy foods would translate across cultures, Hayes isn’t sure. When we talk about spicy food, “we can mean vastly different things, with different health implications,” Hayes says. “That spicy food could be…vegetables, like kimchee. Or it could be…barbecued spare ribs.”

“This isn’t an excuse to go out and eat 24 wings and then rationalize it by claiming they are going to make you live longer,” Hayes adds.

Let’s not forget that eating spicy foods also has some risks. Spicy food can create problems for people with incontinence or overactive bladders, according to Kristen Burns, an adult urology nurse-practitioner at Johns Hopkins Hospital in Baltimore. And some believe that spicy foods can aggravate colds or sinus infections.

Another risk is “heartburn.” Does spicy food trigger heartburn in some people? Yes, but not always. According to Lauren Gerson, a gastroenterologist at the California Pacific Medical Center in San Francisco, a lot of her patients with heartburn (more precisely acid reflux disease, or GERD), were told by other doctors to stop eating everything on a list of 10 trigger foods. The list included favorite foods like chocolate and spicy food.

Gerson told Nutrition Action that these patients were “miserable because their heartburn wasn’t much better” even when they gave up all of those foods. Gerson and her then-colleagues at Stanford University screened more than 2,000 studies, looking for evidence that avoiding trigger foods helps curb acid reflux systems. They found that there wasn’t “any data out there that if you stop these foods…, GERD would get any better.”

So when the American College of Gastroenterology updated its treatment guidelines for GERD in 2013, it concluded that there wasn’t enough evidence for doctors to advise cutting out a whole list of foods. Instead, patients are advised to avoid certain foods only if that lessens their symptoms. The key seems to be “individualized trigger avoidance,” allowing many heartburn sufferers to enjoy spicy food, so long as it doesn’t make their symptoms worse.

The bottom line? If you like the taste of spicy food, and it doesn’t trigger any adverse effects (like heartburn or weight-gain from too many calories), you should enthusiastically munch on the spicy foods you love. According to the latest research, you just might prolong your life.

Bon appetit!