Does your city have the rudest patients in America?

Like death and taxes, rude patients are an inevitability in every doctor’s life. But, some practices have more rude patients than others. Location matters, too, as levels of rudeness differ in various parts of the country. 

So, where are the rudest patients likely to be found? In a recent survey conducted by Business Insider and Survey Monkey, more than 2,000 American adults rated the US cities whose citizens they thought are the rudest. Here are their selections in ascending order, along with the percentage of votes each city received: 

5. Boston, MA - 14.9%

4. Chicago, IL - 18.6%

3. Washington, DC - 18.9%

2. Los Angeles, CA - 19.7%

1. New York, NY - 34.3%

It’s probably no surprise that New York City was voted the nation’s rudest city—and by nearly double the votes as second-place finisher Los Angeles. 

But, according to one Big Apple resident, the notion that New Yorkers are rude is a “stereotype.” 

“We’re just strong-willed,” she told the New York Post. 

Rudeness affects outcomes 

A patient’s rudeness—no matter where they’re from—does more than get under a doctor’s skin. Rude and difficult patients can mess with a doctor’s clinical decision-making, which can backfire on patients in the form of misdiagnosis. That’s what researchers found in a pair of studies published in BMJ Quality & Safety. 

In the first study, 63 family practice residents evaluated six clinical case scenarios, three of which were deemed diagnostically simple and three were considered diagnostically complex. The twist was that some cases also involved “difficult” patients. 

As expected, the residents’ diagnostic accuracy was higher in simpler cases. However, they were 42% more likely to misdiagnose a condition in a difficult patient in a complex case and 6% more likely to do so in a simple case.

“Disruptive behaviours displayed by patients seem to induce doctors to make diagnostic errors,” the researchers concluded—a finding that had been suspected but not demonstrated until this study. 

In the second study, the same researchers assigned 74 internal medicine residents to diagnose eight clinical case scenarios, of which half involved “difficult” patients. (One scenario involved a patient who threatens the doctor and another scenario included a patient who accuses the doctor of discrimination.) 

The residents’ diagnostic accuracy was 20% lower for difficult patients, even though the time they spent on diagnosis was about the same regardless of the patient. Also, residents recalled fewer clinical findings and more characteristic behaviors in difficult patients than in “neutral” ones.

The researchers concluded that the reason why difficult patients cause doctors to make diagnostic errors is “apparently because doctors spend part of their mental resources on dealing with the difficult patients’ behaviors, impeding adequate processing of clinical findings.”

Although most doctors may think that their clinical judgment isn’t affected by emotional situations or confrontations, “the fact is, that difficult patients trigger reactions that may intrude with reasoning, adversely affect judgements, and cause errors,” the researchers wrote. 

So, if this is the case, are more patients misdiagnosed in “rude” cities like New York and Los Angeles? It certainly stands to reason; unfortunately, no studies seem to have investigated this burning question. 

Doctor, reform thyself

But, if the rudest cities have the rudest patients, do they also have the rudest doctors? 

Unfortunately, rudeness may be a widespread problem among doctors, no matter which city (or suburb, or community, or small town) they’re in. According to one study, 31% of doctors said they got hassled by their fellow doctors in the form of rude, dismissive, or aggressive communication. Of note, this study was performed in England, where “manners maketh man.” Imagine how much more pervasive rudeness must be among doctors here in the “in-your-face” United States. 

“There may be a perception that rudeness is a mild word, for a mild problem; that as it is a part of everyday life and resilience to it should be a normal part of our reactions and behaviour,” wrote the authors of the British study. “We have shown that it is a widespread problem with a large impact on individuals and healthcare organisations. Changing this behaviour is likely to be challenging. The recognition that rude, dismissive and aggressive behaviour is damaging and counterproductive is an essential initial message which needs dissemination.”

That’s an important message to remember: Being rude to others doesn’t make people snap to attention or “put them on their game.” Instead, it distracts their attention and throws them off their game.