Not Pimping Just Yelling

You can have discussions about patient safety in some of the oddest places, like the breakfast room in a hotel in Munich. My husband and I are here in this German city, en route to Heidelberg where I am speaking at a nursing conference and at the medical school, where I will talk about Team Intelligence. This morning, we were sitting next to a couple who were also eating breakfast and we began to chat with them.

Turns out he’s a surgeon and when I told him I am a healthcare journalist and researcher, well you guessed it, we started talking about my favorite subject — teamwork. He acknowledged that teamwork is critical in the Operating Room. Yes of course, we must work on teams, he said. Once the word team came up, however, the usual happened. He became just a tad bit nervous and asserted that as important as teamwork and teams “strong leadership” remains. After all, I am the one who is responsible, he argued. I am the one who will be held legally liable, I must make all the ultimate decisions. I must be the captain of the ship.

I suggested that there is no inherent conflict between leadership and a flattened hierarchy. One can have strong leadership without steep hierarchies. Ah, he said, I must think about that. And then he began to talk about all the times he has been in the OR working with people with whom he has not worked before and whose skills, he feels are not quite up to snuff. I can’t remember the exact examples he used but it had to with people not knowing how to lay out what he needed in the OR, which could lead to delays, risk of infection, etc. “So, of course, when that happens,” he said, “ I have to yell at them.”

As I write,  I don’t want to give the wrong impression – particularly about a physician who seemed nice, friendly, and with me, at least, seemed to be a good listener, and to care about his patients and their positive outcomes. He was also – at least in a non-work setting – a very generous guy, willing to give a stranger (i.e my husband) if not the shirt off his back, the scarf around his neck (which he insisted my husband take as a gift because he had been admiring it and had planned to shop for one just like it.)

By his own admission, however, when this same physician found himself in the operating room, and frustrated by the failings of his co-workers, his manner was different.   As the need arose, he cheerfully confessed to raising his voice to a decibel level he described as yelling in order to correct their behavior or improve their skills. His rationale for this form of on-the-job- training was patient safety and enhancing positive outcomes.

This is not “pimping”, which is quite different, but it is just as problematic. What too many people fail to understand is that raising the volume is no more effective at skill-building than it is at getting someone to understand you when you don’t speak their language. Just there is no no scientific data establishing a correlation between high decibel communication and effective communication in language acquisition, there is also no data that suggests that shouting at people and skill acquisition or improved task performance.   In fact, science very clearly establishes that when people are yelled at they go into fight or flight mode and do not perform optimally. The psychologist Amir Erez has found that experiencing episodes of rudeness – which is what yelling definitely is — disrupts multiple aspects of normal cognitive functioning. For example, performance on visual tasks was degraded causing subjects to miss critical information; working memory and control of attention was disrupted, with similar effects; and goal management, planning and execution were damaged. Even “just being around” episodes of incivility, even if they were not directed at the subject, had these effects.

I have no idea if the surgeon in question will ever read this blog post. If he does I hope he takes it in the spirit in which it is intended. Of course, under stress, many of us become angry and frustrated and may end up yelling. Yelling, while understandable, is not acceptable, particularly not when it can impact performance in settings like the operating room or hospital, where patients depend not only on the skill of healthcare professionals but their emotional reactions under stress.