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BMJ. 2019 Dec 18;367:l6446. doi: 10.1136/bmj.l6446.

Q fever-the superstition of avoiding the word "quiet" as a coping mechanism: randomised controlled non-inferiority trial.

Author information

Department of Microbiology, Lancashire Teaching Hospitals NHS Foundation Trust, Fulwood, Preston PR2 9HT, UK
UCSF Centre for Tuberculosis, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
Centre for Clinical Microbiology, University College London, London, UK.
Department of Microbiology, Lancashire Teaching Hospitals NHS Foundation Trust, Fulwood, Preston PR2 9HT, UK.



To determine the validity of the superstition that utterance of the word "quiet" in a clinical setting increases workload.


Prospective randomised controlled non-inferiority study.


Microbiology department of a large teaching hospital in Lancashire, UK.


Two members of the medical microbiology team carried out the duty work on any given week day and an on-call team member on any weekend day. 29 days were assigned in which staff were to say "Today will be a quiet day" and 32 days were assigned in which staff were to refrain from saying the word "quiet" in any context.


Each day was randomly allocated to either saying "Today will be a quiet day" (intervention group) or refraining from saying the word "quiet" (control group) in any context.


The primary outcome was mean overall workload: a composite of number of clinically related telephone calls, clinically significant results, or validated results processed by the duty medical microbiology team during a 24 hour period referred to collectively as "clinical episodes." A difference of 30 clinical episodes was considered as the margin of non-inferiority. Secondary outcomes included the individual components of the primary outcome.


Workload was measured each day over a 61 day period (1 May to 30 June 2019). A mean 139.0 clinical episodes occurred on control days compared with 144.9 on days when the experimental intervention was uttered, a difference of 5.9 (95% confidence interval-12.9 to 24.7). The upper bound was less than the specified margin of 30, providing evidence for non-inferiority. No evidence of a difference in workload was found between interventions with any of the four components, whether considering unadjusted or adjusted analyses, or looking at the subgroups of week days or weekends.


The study findings refute the long held superstition that utterance of the word "quiet" impacts on clinical workload, and therefore it should not be avoided. In the era of considerable staff shortages and increased work related stress, doctors should look to other methods to increase resilience and protect their wellbeing and mental health.


Lancashire Teaching Hospitals NHS Foundation Trust's research department SE-259.

[Indexed for MEDLINE]
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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at and declare: no support from any organisation for the submitted work no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

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