As a senior doctor, to be rude to a medical student or a resident is to fall short of being the teacher you hoped to be; to be rude to a patient or a family member is probably to fail as the physician and human being you thought you were. And from the point of view of that patient or that family member, the medical hierarchy is often somewhat opaque; if someone has been rude to you, you may not know whether this is the clumsiness of a nervous trainee or the arrogance of a senior doctor with god delusions.

Sometimes rudeness comes from pressure, and heaven knows there is plenty of pressure in medical settings. In the “Sticks and Stones” article, the only context in which there was some justification for rudeness was when patient safety was at stake and someone spoke sharply to demand immediate action or to reprimand someone for a mistake.

And of course, when you know you’ve made a mistake or put someone at risk, you may become that much more sensitive. Many years ago, I made an intern cry on morning rounds by asking more than once why he hadn’t checked a certain blood test; he clearly experienced it as a public shaming, with a strong suggestion that he had risked the patient’s life. Was my manner a little thoughtless? Probably, and maybe even a little righteous; the intern’s well-being was not my priority. But it’s hard to see that the public shaming helped the patient — or the doctor.

Sometimes rudeness is a matter of perception. When my mother was in the hospital three years ago, I felt irritated when one of the rounding doctors kept looking down at her phone, even though she probably was using the phone to act on every one of the decisions being discussed, changing drug doses, ordering labs, requesting consultations, or at least, making notes to herself to do those things. It was a generational problem, I told myself; if she’d been scribbling on a clipboard, I wouldn’t have minded.

In almost any setting, rudeness does tend to beget rudeness, whether because the top people in a hierarchy are modeling it for those they should be teaching or because it engenders anger, stress and a desire to strike back. It’s not enough to say rudeness is unprofessional, so therefore don’t be rude. And it’s not enough to say, being affected by rudeness would be unprofessional, so therefore, I’m not affected.

Rudeness affects your spirit, your morale, your connection to your job and your effectiveness in that job. It gets in the way of health, and it gets in the way of healing.