TIME health

How Rudeness Affects Medical Professionals and Their Patients

Disruptive physicians can harm the performance of those around them

When someone makes a nasty quip, cuts us off in traffic, ignores our suggestions or takes credit for our work, we get mad, sad and even angry. Rudeness, even just little, can really hurt. We know these reactions can be harmful, both to ourselves and those around us, but recent research suggests that the emotional reactions we have to rudeness tell only half of the story. There are cognitive effects we are not even aware of. In fact, this is what I study – how experiencing rudeness can damage performance by affecting our thinking and decision-making.

For example, in a recent study, my colleagues and I found that when people experience rudeness, they unknowingly become biased toward rude interpretations of social interactions. In other words, when we experience rudeness, we tend to think others are being rude to us as we go forward.

Rudeness has also been shown to draw cognitive resources away from individuals, causing them to perform worse and make more mistakes: for example, not remembering details of a conversation.

If you are writing up a report or making a hamburger for dinner, the costs of mistakes are inconvenient. Imagine if you are a doctor working on an infant in a NICU? Suddenly, the costs of simple mistakes caused by rudeness become much bigger. Shockingly, this is exactly what we found in a new study – rudeness causes medical teams to perform worse, and ultimately this could have huge costs for patients.

Disruptive behaviors in medical settings

When researchers think about ways to improve the performance of doctors and nurses, they typically focus their studies on procedures, devices, and medicines that can improve the ways we treat illness and injury. But there is more to good performance than better procedures or better devices.

Recently, researchers have started to explore what they call disruptive behaviors – behaviors that make it harder for people to work together or communicate – in medical settings. Often these studies focus on negative interactions between doctors and nurses.

Sometimes referred to as disruptive physicians, doctors who treat nurses poorly can cause nurses to become stressed about their jobs and have lower job satisfaction. There is some evidence that disruptive physicians can harm the performance of those around them. But can they really harm patients? That is what we wanted to find out.

Often disruptive behaviors involve major negative interactions, like screaming at a nurse or harshly insulting a colleague. However, other research suggests that simple incivility can have very harmful effects. So, in addition to exploring whether disruptive behaviors can harm medical team performance, we also sought to explore whether an encounter as minor as incivility could be disruptive.

Disruptive docs make their colleagues perform worse

To find out if and how rude physicians harmed patients, we conducted an experiment in a simulated neonatal intensive care unit (NICU). The experiment involved 24 medical teams (one doctor, two nurses on each team) in Israel that completed a simulation where they had to correctly diagnose a newborn whose condition was declining rapidly.

In the simulation, the baby in the NICU had necrotizing entrocolitis (NEC), an inflammation in the intestines, which can lead to tissue death. NEC is rapidly progressing condition that can quickly result in death if not treated quickly. Teams were not told of the infant’s condition prior to the simulation – they had to diagnose the condition themselves.

We chose NEC for the simulation because it progresses so fast, and the proper treatment requires quick and accurate diagnosis and treatment. The effects of rudeness in this type of setting would be readily detectable.

Before the simulation started, the teams received a welcome message from an experienced physician who was watching the procedure. In half of the teams, during this welcome message, the doctor said that he had not been very impressed with the performance of medical professionals in the country in which this experiment was taking place, thus offering a very slight bit of incivility prior to the start of the experiment. After the medical teams had completed the simulation, we had three independent judges (who didn’t know we were studying the effect of incivility) rate the performance of the doctors and nurses.

The results were staggering and frightening. The groups that were exposed to the rude comment did far worse in the simulation. A simple insult from a third party virtually destroyed the performance of the participants. Both their diagnostic skills and their performance suffered dramatically – meaning not only did they have a harder time figuring out what to do, but that even when they knew what to do, they had a harder time doing it.

A small slight can be a pretty big deal

This study shows that the consequences of simple negative social interactions can be catastrophic. Most people’s attitude toward rudeness is that it’s not that big a deal and people will “get over it.” More and more, researchers are finding that this isn’t true – this study shows that in certain contexts the consequences of rudeness can be deadly.

This is especially troublesome due to the fact that these behaviors are very common – a 2010 study suggested that nearly two-thirds of operating room staff had witnessed these behaviors in the OR, and more than half said they had been on the receiving end of these types of behaviors.

However, this conclusion is not limited to doctors. Imagine a similar situation for truck drivers – simply being cut off by a driver can cause a deadly accident down the road. Maybe you should think twice before you weave around that semi next time you’re driving to the beach.

This article originally appeared on The ConversationThe Conversation

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME society

Law Enforcement Should Learn To Recognize the Signs of Mental Illness

The Crisis Intervention Training teaches how to address mental illness matters in a health-oriented rather than enforcement manner

The untimely death of Sandra Bland in a rural Texas jail last month has led to many unanswered questions.

Texas prison authorities say Bland hanged herself with a plastic garbage bag in her cell, a claim her family has questioned. Many suspect that Bland was murdered by corrupt law enforcement officials or correctional officers.

Lost in the emotion of yet another tragic death of a young African American in police custody is the real possibility that untreated mental illness led to Sandra Bland’s death.

Regardless of what happened in that Texas jail, Centers for Disease Control data tell us that rates of suicide have seen a steady increase each year since 2000. Suicide is now the 10th leading cause of death among all Americans.

And, while African Americans have lower suicide rates relative to whites, the rate of suicide among African-American males and females has also been climbing each year since 2009.

As a mental health services researcher, I’ve spent years examining factors that prevent vulnerable youth from getting mental health services. My work as a psychotherapist has involved treating folks suffering from depression – folks like Sandra Bland who told police she had tried to commit suicide last year.

The importance of the social network

Sociologist Bernice Pescosolido suggests that mentally ill individuals don’t decide about getting treatment in a vacuum. Those closest to the individual are critical to facilitating entree into care, providing care or doing nothing.

Through my work, I have seen how serious mental illness such as chronic depression or bipolarity can wreak havoc on not just the ill individual, but also on their families and friends. In a sick individual’s social networks, accusations fly. Loved ones duck for cover or they hold back for fear of offending. At this unstable and vulnerable juncture, finding a way to treatment is difficult and staying in treatment is even tougher.

Depression is one of the most debilitating health issues anyone can experience. It is a leading cause of engagement in suicidal behaviors – a precursor, of sorts, to suicide.

At the same time, depression is one of the most successfully treated mental illnesses. Both talk therapies and psychotropic medications are replete with evidence of their successes in the treatment of depression.

The problem is that not enough people with depression actually receive treatment. The numbers vary widely by age and race. Approximately one third of youth with depression receive treatment. That number increases slightly – to about one half – for 20-somethings like Sandra Bland. The lack of care is even more disproportionate in ethnic minority communities relative to white communities. African Americans, Latino Americans and Asian Americans all have lower treatment rates.

My own research indicates these groups are also likely to have greater connections to their families and friends, who pray with them about their condition or offer advice. This might help explain their overall lower rates of suicide relative to whites.

Responsibility of law enforcement

While it is critical for social network members to both see and do something to help their loved ones get connected to treatment, it is equally critical for law enforcement to be trained on how to successfully address interactions with the mentally ill.

Imagine for a moment what would have happened if Sandra Bland had been pulled over by a police officer who was trained to recognize if she was suffering from a mental illness that required immediate attention. Imagine a police officer having the skills to engage Bland – or many others much like her – in a process of recovery.

That novel notion is being carried out by Dr Michael Compton and others who implement the Crisis Intervention Training, a program that trains law enforcement officials on the signs and symptoms of mental illness and how to address these matters in a health-oriented rather than enforcement manner. This program has helped police redirect countless individuals into mental health treatment instead of jails. Indeed, successful CIT programs have emerged all over the country, including in Memphis and Chicago.

The circumstances surrounding Sandra Bland’s death remain unclear. But many who are struggling with a mental illness surround us. Paying attention to the signs and having true engagement with the presenting behaviors can save lives.

This article originally appeared on The ConversationThe Conversation

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME Family

To the Husband From the Wife Who Has Depression

Please, if you notice the cloud before I tell you, just hug me tight and tell me we’ll fight it together

Dear Husband,

I love you dearly, more than anything in this whole world. I think you already know this. I know you love me too, I just forget sometimes. Depression clouds my mind and fills me with horrid thoughts about how unlovable and worthless I am. Sometimes I believe you, sometimes I believe depression.

I know you prefer the good days when I’m happy and not anxious or snappy, and I wish I could have these days every day. But I can’t. I feel the cloud approaching and it petrifies me. Sometimes I tell you and sometimes I don’t. Please, if you notice the cloud before I tell you, just hug me tight and tell me we’ll fight it together. Please don’t ask me if I’m OK — my automatic answer will be yes. In reality, it’s a big no. You see, depression can make you feel ashamed.

I know sometimes I overreact about the smallest things and get angry, but please be patient with me. Forgetting the bread will not be the real reason. It’s that I feel like I’m losing control over my mind. Depression is very clever, you see – it builds up a wall of anger piece by piece, and you never notice it until it’s so big it begins to topple over. I’m sorry you get the brunt of my anger on cloudy days. Please forgive me. Please. Just tell me you love me and leave me to calm down.

I know it’s hard to help somebody through depression if you’ve never experienced it yourself. I understand. I totally get it. Just listen to me and ask about the cloudy days. I can’t just bring it up in conversation. Depression clouds your mind. I need you to break the silence.

There will be lots of times I feel like you’d be better off without me, or that my children deserve a better momma. Sometimes I’ll tell you. Most of the time I won’t. Sometimes I can go for months without those thoughts crossing my mind, and other times I think about them every second of every day for weeks. That’s the scary truth. Depression is vile — a vile, nasty monster. Please always keep an eye on me, but know no matter how many times you tell me I’m worth it I probably won’t believe it on cloudy days – but please never stop telling me. Ever.

I love our children more than anything, but sometimes I feel like a failure. I feel like a rubbish momma. My mind nags me and tells me other mommas do things better and love better than me. I feel like I always fall short. I find it so hard being a momma on cloudy days, but I try so hard to not let them notice the clouds. I hope you know I try.

I haven’t self-harmed since February 2010, but the urge often consumes me. When the black cloud is here it consumes my mind. I fight it so hard for myself, my children and for you. I know it’s hard to understand why I crave it, I can’t explain it myself. It’s like an old addiction that comes to hurt me when it smells the dark cloud. One day I hope it won’t ever cross my mind again.

I know I don’t talk about these black clouds often, but I want to. I hate the silence it forces me to keep. There’s a certain freedom when it comes to talking openly about the monster. Help me find that freedom.

Depression makes me feel tired. Sometimes the fatigue is so bad I just want to cry. Every bone hurts. Sometimes I lay awake at night and worry about things that won’t even happen. Squeeze my hand tight if you’re awake too.

Sometimes it takes every bit of motivation to get up in the morning, but I never let you in on this. A new day often scares me. I wonder, will I cope? Will the sky be blue or black? Is the weather nice? Every single morning is hard, but seeing you makes it easier.

I want to publicly thank you for loving me and supporting me. You are the best.

Yours forever x

This article was edited and published on The Mighty with permission from Swords and Snoodles

More from The Mighty:

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME Innovation

Workplace Rudeness Is Contagious

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

These are today's best ideas

1. It’s not your imagination. Workplace rudeness is contagious.

By Alisson Clark at the University of Florida

2. Here’s why it makes sense to help prisoners get a college education.

By Ellen Condliffe Lagemann in the Conversation

3. It just got easier to tell companies not to track your every move online.

By Aaron Sankin in the Daily Dot

4. We should secure the web today against the quantum computers of tomorrow.

By Tom Simonite in MIT Technology Review

5. Could your child’s picky eating be a sign of depression?

By Alice Park in Time

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME Mental Health/Psychology

How Effective Are PTSD Treatments for Veterans?

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Though many treatments for PTSD can alleviate symptoms, veterans continue to meet the criteria for the disorder

A new study published Tuesday suggests commonly used first-line treatments for PTSD in veterans may not work as well as medical experts once thought.

The number of American veterans who suffer from PTSD continues to be a serious national public health problem. Recent data show that more than 200,000 Vietnam War veterans still have PTSD, and other research shows that around 13% of Iraq or Afghanistan veterans who experienced combat have PTSD. The numbers continue to climb. As TIME previously reported, PTSD diagnoses among deployed troops grew by 400% from 2004 to 2012.

Now new research, published Tuesday in the Journal of the American Medical Association, reveals that go-to treatments for the disorder may not be as effective as many in the medical community may have believed or hoped. To reach their findings, researchers from the Steven and Alexandra Cohen Veterans Center for Post-Traumatic Stress and Traumatic Brain Injury at NYU Langone Medical Center reviewed 36 randomized control trials of psychotherapy treatments for veterans suffering from PTSD over a 35-year span. Two of the most commonly used treatments—and the most widely studied—are cognitive processing therapy (CPT) and prolonged exposure (PE) therapy.

CPT is a treatment that focuses on changing dysfunctional thoughts, and exposure therapy is meant to help patients face what’s causing them stress and fear.

The research showed that while up to 70% of the men and women who received CPT or PE experienced symptom improvements, around two-thirds of people receiving the treatments still met the criteria for a PTSD diagnosis after treatment. The researchers note that current veterans affairs policies emphasize the use of the two methods as treatments of choice.

The researchers also argued that veterans with PTSD are likely to have worse outcomes from treatment compared to civilians with PTSD. Though the researchers are unsure why that is, there’s some speculation: “Compared to civilian traumas such as car accidents and natural disasters, military deployment involves repeated and extended trauma exposure,” says study author Maria M. Steenkamp, an assistant professor of psychiatry at NYU Langone. “It also involves not just life-threat, but exposure to traumatic losses and morally compromising experiences that create shame and guilt.” Veterans are also more likely to have additional mental health issues such as anxiety or substance abuse, she adds.

The researchers also raise the question of whether focusing on trauma during PTSD treatment is really that effective. Based on their review of the trials, they found that when CPT and PE were compared to non-trauma focused psychotherapy, patients showed similar improvement.

However, not everyone agrees that the findings should be cast in such a light. Dr. Paula Schnurr, the executive director of the National Center for PTSD under the U.S. Department of Veterans Affairs says there’s not consensus that veterans have a more difficult time overcoming PTSD symptoms compared to civilians, and adds that some people who treat veterans feel avoiding fears and trauma perpetuates problems, rather than processes them. In addition, symptom improvement is an important part of PTSD treatment since it improves veterans’ quality of life. Schnurr was not involved in the study, though some of her own research was analyzed in it.

“If a person has a meaningful response, they have a meaningful improvement in their quality of life,” says Schnurr, adding that many treatments for other mental health conditions have similar outcomes. “As scientists we will always try to enhance the effectiveness of these treatments for more people…My takeaway message [from the study] is one of optimism and also encouragement for people to seek treatment.”

The researchers say other treatment options should continue to be explored, and there are practitioners who are trying different methods, from acupuncture to healing touch therapy. Another new study published Tuesday in JAMA looked at 116 veterans with PTSD who either underwent mindfulness-based stress reduction therapy that focused on being present and non-judgmental in the moment or a present-centered group therapy that focused on current life problems. The results showed that those in the mindfulness group had a greater improvement in self-reported PTSD symptom severity. However, they were no more likely to lose their PTSD diagnosis.

There may not be a cure yet for PTSD, but the amount of research looking into how to improve or innovate treatments is encouraging. Veterans who need support can find resources here.

TIME mental health

Shirtless Marines March in ‘Silkies’ to Raise Suicide Awareness

Each day, 22 former servicemembers commit suicide

A group of Marines is marching 22 kilometers, or about 13.5 miles, wearing nothing but short shorts—called “silkies”—and hauling 22 kilograms, or about 50 pounds, of gear to honor the 22 service members who commit suicide every day.

“Imagine a pub crawl with all your Marine buddies wearing nothing but silkies and rucks on the most crowded and beautiful boardwalk in California. That’s what’s going on here,” a Facebook page for Sunday’s event, “22, with 22, for the 22, in silkies,” says. The event is co-sponsored by two veteran support groups, Irreverent Warriors and VETality Corp.

The journey begins at South Mission Beach Jetty in San Diego and will end at La Jolla Cove.

Each day, 22 veterans—or about 8,000 former military servicemembers—commit suicide.

 

TIME mental health

There’s a New Treatment for Severe Depression—With Fewer Side Effects

Brief pulses of electricity have fewer side effects than one prolonged jolt

One of the most common ways to treat for severe depression has been electroconclusive therapy (ECT), where electric currents are passed through the brain to trigger brief, intentional seizures to stabilize brain chemistry.

New research published Tuesday in the Journal of Clinical Psychiatry suggests, however, that a new method—ultra-brief pulse right unilateral, or (RUL) ECT—may have fewer negative side effects, like confusion, and memory and heart problems.

The study used data from 689 patients with a median age of 50 from six countries. “Our analysis of the existing trial data showed that ultra-brief stimulation significantly lessened the potential for the destruction of memories formed prior to ECT, reduced the difficulty of recalling and learning new information after ECT and was almost as effective as the standard ECT treatment,” saud Colleen Loo, professor at the University of New South Wales.

While ECT sends a single, controlled electric current to the brain’s prefrontal cortex—shown to be underperforming in patients suffering from severe depression—(RUL) ECT sends brief pulses of electricity, reducing total stimulation of the prefrontal cortex by one-third.

Loo noted that more research is needed, but emphasized the study’s promising outlook on not only being more efficient and safer for patients but also reducing the stigma depressed patients suffer.

“This new treatment, which is slowly coming into clinical practice in Australia, is one of the most significant developments in the clinical treatment of severe depression in the past two decades,” she said in a press release. “We are still working hard to change the broader medical profession’s and general public’s perception of ECT, which has struggled to shake off the tarnished image given to it by popular movies such as the 1975 film, One Flew Over the Cuckoo’s Nest.”

TIME mental health

Study Finds That Women Slip Into Dementia Faster Than Men

Senior woman covering face with her hands
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The study has no medical implications quite yet

Women who develop slight memory deficits and mental decline slide faster toward dementia than men, according to a new study presented Tuesday at the Alzheimer’s Association International Conference in Washington.

Researchers were quick to note that the study’s findings aren’t reflective of a difference in brain chemistry between genders and have no medical implications just yet. “All we can say at this point is that there appears to be a faster trajectory for women than men” in the direction of dementia, said P. Murali Doraiswamy, a professor of psychiatry at Duke University’s Institute for Brain Sciences and lead author of the study.

The study used cognitive test scores from 398 participants of both genders who were primarily in their 70s. After controlling for outside variables like education and genetics, the researchers found that women’s test scores fell by an average of two points per year, compared to just one point for men. This wasn’t the only negative effect for women: their standard of life—how they performed at home, work, and with family—also fell faster than men.

A vast majority—nearly two-thirds of the five million Americans afflicted with Alzheimer’s disease—are women, which scientists note can be traced to the fact that women live longer, but the reasons for their decline have remained indeterminate.

[New York Times]

 

TIME Mental Health/Psychology

Children With Mental Health Problems Are Also at Risk as Adults

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A new study suggests that psychiatric problems in childhood are linked to several negative outcomes in adulthood

Having psychiatric problems in childhood is challenging enough, but new evidence suggests that these problems can lead to issues as an adult—even if the problems do not persist into adulthood.

A new study published in JAMA Psychiatry used data from a survey of 1,420 children from 11 counties in rural North Carolina. The children were followed over time and assessed annually between ages 9 and 16 for common psychiatric problems, like depression, anxiety and behavioral issues. The researchers found that 26% of children in the group suffered some form of behavioral or emotional disorder; another 31% displayed “subthreshold” psychiatric problems, or a few symptoms of psychiatric problems without being diagnosed with the condition.

“In terms of most types of health problems, kids are the healthiest,” says lead author Dr. William Copeland of Duke University Medical Center. Most chronic health diseases take hold during middle age, but “one exception is mental health problems, which occur at the onset of childhood and adolescence,” he says. These can include ADHD, behavioral or conduct problems, anxiety and depression.

Out of the initial survey group, 1,273 people were later re-evaluated three times at the outset of adulthood—ages 19, 21 and 25—to see how the now-young adults had fared in four areas: health, the legal system, personal finances and social functioning. These included negative life events like being incarcerated, dropping out of high school, having trouble keeping a job and having a serious health problem or addiction, Copeland says. “Nineteen and 21 are a peak period in terms of criminal behavior, substance problems, and transitioning from the home,” he says, and age 25 is when things typically start to stabilize.

Of the young adults who had suffered from a subthreshold psychiatric problem in childhood, 42% suffered an adverse outcome in adulthood. Of the kids who had behavioral or emotional issues as kids, 60% of them reported having trouble as adults. By comparison, just 20% of the young adults who had no psychiatric issues reported adult problems.

In other words, having a diagnosed psychiatric issue as a child made him or her six times more likely to experience at least one adverse effect as an adult and nine times more likely to suffer from two or more adverse outcomes. Children who had subthreshold symptoms without an official diagnosis faced three times the risk of having one adverse outcome and five times the risk of having two or more adverse outcomes.

Copeland thinks this is proof that mental health needs to be addressed early on and without stigma. “We need to focus on prevention and intervention,” he says. “If we want to reduce the cost and distress associated with many social problems, we really need to address them earlier.”

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