Mrs V had a terse and demanding way even as she appointed by phone for her initial examination. She made it clear that she does not take kindly to waiting anywhere— including doctor’s offices. You recall that her first visit was scheduled during a busy afternoon that included a chaotic mix of multiple broken brackets, an ill-fitting RPE appliance, and a child who had a messy accident as a result of an upset stomach. You were thus 20 minutes late for Mrs V’s appointment, but she had little empathy for your predicament. She brusquely let your receptionist know about her dissatisfaction.

Your staff scheduled her next consultation during a quiet morning to be certain that you would be on time for her appointment. As you enter the operatory, she is speaking on her cell phone, belligerently contesting a credit card bill with her bank. She remains unfazed by your entrance and continues her telephone diatribe. You excuse yourself to place a bracket for the patient in the next room; when you return, she’s still on the phone. She acknowledges you by raising her arm in an animated way and then looks directly at her watch. You bite your lip to avoid telling her exactly how you feel.

The increased level of rudeness that pervades our society is evident in multiple arenas. One prime example is the airline industry. With extensive reliance on technology to herd customers, the personal side of passenger communication is all but extinct. Communication with passengers is now almost exclusively electronic. A palpable tension pervades the boarding queues as passengers vie for overhead luggage space to avoid checking their bags. Passengers are compressed from all sides as the guy in the next row abruptly jerks back his seat to recline without warning or apology. Communication between people becomes increasingly rare as ear buds fill ears and headphones clamp heads. Passengers close their eyes as an efficient way to escape from one another. On trains and buses, the best way to avoid the temptation to forfeit a seat to an elderly passenger or an expectant mother is to pretend one sees neither. Pervasive rude behavior is reported when driving (72%) and shopping (65%). Six of 10 people can recall a recent incident when they were rude to others.

Rudeness pervades in the workplace, schools, and office. Return phone calls are almost a rarity unless the caller perceives a benefit for himself. Cell phone conversations are anything but muted. Even the tone of social media’s dialogue can often be contentious and abrasive. As people become more adept at communicating using technology, there is decreased emphasis and value placed on direct personal interaction.

Discourtesy is not solely a contemporary phenomenon. Historians have implicated rudeness as a factor in the fall of the Roman Empire. The Romans placed great emphasis on civility, treating their adversaries with respect in both debate and battle. Civility constituted reverence for societal order, providing guidelines for acceptable behavior. As courtesy waned, “overconfidence and complacency” replaced civility, which led to a “step toward anarchy where anything goes, regardless of the consequences.”

In the medical arena, not only has the quality of care been shown to decrease in an atmosphere of rudeness, but also rudeness often propagates rudeness. Communication between health care providers has been shown to diminish in an arena of discourtesy, detracting from quality.

Civility begins in the home, should be amplified at school, and must be practiced at the managerial level in business. In your case, perhaps any effort to change Mrs V’s behavior will be futile, but as we act as leaders of our own enterprises, we must be role models of courtesy—both in and out of the office. Often it’s a tall task, but few disagree that there’s no better way to communicate than by example.