Consider the emotionally charged atmosphere of a hospital's neonatology unit, where critically ill newborns typically need 24-hour, highly specialized care from a team of professionals. That's the environment in which researchers from Tel Aviv University tested whether everyday rudeness can hurt the quality of health care.

The researchers asked 24 teams from neonatal intensive care units around Israel to participate in a simulation exercise: The "patient" (actually a mannequin in an incubator, hooked up to monitors) was suffering a serious but common complication called necrotizing enterocolitis, in which bowel tissue disintegrates. The professionals were told that a "visiting expert" on how teams function would be observing their procedures by live video, occasionally using a two-way link to communicate with them.

Half of the teams got an "expert" who was told to make only "neutral" comments; the other half got a "rude" one. How rude? Actually, not very. "I can't say I'm impressed with the quality of medicine in Israel," the rude expert said, and later commented that the staff "wouldn't last a week" in his department.

Management experts then analyzed videotapes of the simulations in terms of how the teams shared information, whether they sought help when they needed it, and their overall diagnostic and procedural skills. They found that the teams with the rude observer performed much worse than the ones with the neutral expert; by comparison, the performance difference was twice as great as the gap between well-rested medical teams and those suffering from sleep deprivation.

Those rude comments were "fairly benign," researcher Arieh Riskin told Reuters, making it clear how even small failures of courtesy can make a difference. "Incivility is rampant in our society and almost all people get exposed to it sometime or the other, and medical teams aren't well aware of how risky it is to our performance."