Response

We thank Mayur Lakhani for their comments with which we fully agree. Our study was confined to communication within teaching hospitals but rude, dismissive and aggressive (RDA) communication is also likely to occur in non-teaching hospitals and across the primary–secondary care interface.¹

The ephemeral, impersonal nature of a phone call and the lack of a pre-existing relationship between clinicians are both risk factors for rudeness.² Individuals can reduce their risk of RDA communication by building relationships across primary and secondary care, but this is not a global solution.

There are few, if any, measurable outcomes currently available to detect or discourage rudeness and we agree research is needed to define, measure and report the extent of the problem. Recording phone calls ‘for training purposes’ may be an initial step towards this.

Departments may have poor organisational handling of referral activity, such as one doctor with a bleep who has multiple other duties. This promotes rudeness and the effects are worse in high intensity specialties. We agree that defining professional standards of communication and promoting respect are required steps but meaningful cultural change will not arise from a document alone and needs to be driven by leadership.³ This will require persistent promotion by chief executives and other senior leaders if it is to have any impact. Jeremy Hunt has not set a good example of respect in communication.