Physician Conflict Management- How You Deal with Conflict Matters

Physician Conflict Management- How You Deal with Conflict Matters

Take a guess how many google entries there are for the search term “disruptive doctor”? Did you guess 21.2 MILLION in 0.7 seconds?  Sounds crazy, right?

Author: Robert A Felberg MD

Topic: Conflict Management, Physician Leadership

Keywords: conflict resolution in medicine examples, conflict management in healthcare setting, Disruptive physician program

We’ve all seen the rude doctor who responds like an immature child or abuses the staff, but did you realize that the issue is this widespread?  Maybe, just maybe, we’ve all been a little (or a lot) guilty of this offense as well… But who can blame us?   We’re working crazy hours on no sleep, we get abused every day from all angles, everyone else gets to treat us poorly, but the second we even raise our voice to complain about the 22nd peer-to-peer call that afternoon, we get labeled “disruptive”.     Sometimes it’s seems like everyone else is making my environment hostile, but we’re the only ones who get in trouble for it!

OK, You’ve had your chance to vent… Remember- It’s OK to have emotions, it’s not OK to allow emotions to have you. Especially when you are in an asymmetrical relationship and hold more power.

Conflict Defined: Conflict is a disagreement about the use of shared resources, between interdependent parties, and involving negative emotions. 

Delving into this definition of reveals a lot  about how conflict occurs and how it can be addressed.

  • You can only really be in conflict about shared “resources”- the term resources can be used loosely here. These resources can include obvious things like finances, materials, staff, or time. It can also involve “relationships” or “persons” if you think of relationship in the strictly economic sense- you can easily enter a conflict about the treatment of another person or groups of people. The closer that person is to you or your identity, the stronger the pull to jump in.
    • Consider this- The other party may not truly understand the nature of your concern. Sometimes you aren’t even aware why you are getting emotionally charged. We’ve all experienced a person “blowing-up” over something seemingly minor and not understanding why they are so upset.  Before you escalate a conflict- are you aware of why they are upset and have you calmly let the other party express their concerns? Maybe the resource has little value to you and you can readily concede it, once you understand the issue.
      • For instance, your nurse must pick up his son at soccer practice in twenty minutes.  You need him to assist in a procedure.   He starts to get visibly upset.   Rather than responding like you often do at the end of a rough day by escalating the conflict, you ask him to take a break, calm down, and explain why he is upset.   After you learn the reason, you offer to pay for a taxi for his son if he can supply the receipt.
  • You are interdependent or rely on the other party. That means, that even if there is a power difference– think you and a nurse or you and the president of the hospital- there is more to be lost than just the direct disagreement. You also risk souring the relationship.  In most health care related conflicts, the relationship is worth 75% percent of the final agreement.  (note: I’ll cover the role of relationship in another blog post.   Please sign up to the newsletter to be kept up-to-date) You need to keep a few things in mind when you enter a conflict
    • You are rarely just at odds about the immediate issue at hand. You are also conflicted about the nature of the relationship. If the relationship breaks down the harm can be considerable, far worse than you initially believe, and can harm more than just the parties involved.
    • Because of the interdependence of the two parties, the role of power gets magnified. If a physician gets into a conflict with a lab tech, the perceived power difference- real or not- gives you the appearance of a 6’4” football linebacker picking on a kid in a wheelchair.  You will always be the bad guy, even if you think your response was appropriate. The counter argument will always be, “you are a doctor, you are not permitted to lose your cool at any time.”  Unfortunately, it doesn’t work the other way- The president of the hospital may have more power, but if you respond poorly to his abuse, as a physician have little recourse because your power is considerably higher than the average person. Think of the world’s smallest violin joke as the common reply when you complain.
  • Conflict is associated with negative emotions. This is the most important defining characteristic of conflict. We interact with people all day long about the use of resources and different behaviors, without getting overly emotional. If we both want pizza for lunch, we get along swimmingly.  If you want pizza and I want Chinese take-out, and I accuse you of always making demands and never caring about what I want, suddenly we have a problem.
    • Conflict minus Emotions equals Negotiation.  As a physician, negotiation is the single most vital professional skill-set you can learn. If you can avoid or defuse the emotional aspect of the disagreement, focus on the actual issue at hand, be honest with each other, and keep the relationship in mind, you’ll find most work conflicts can be managed- sometimes more easily than you can imagine.
    • Emotions are internal “facts”. The emotional state of yourself or the other party is as real as any other “fact” of the negotiation. The price of a dozen oranges is $3.25 is just as relevant as “I am worried” when it comes to resolving a conflict. Keep this in mind as you move forward.
      1. Do not belittle the other’s persons emotional state. Doctors do this often. They hear that OR nurse is tearful after you humiliate her and you respond, “They need to toughen up. This is medicine, not a beauty pageant!” Instead, you should consider saying, “Wow. I had no idea they were so upset. I’d really like a chance to apologize when she feels better.” You don’t need to “give in” on the disagreement, but rather apologize for worsening the harmful emotional state. Or at the very least recognize it – “I see you are very upset. That wasn’t my intention. I hope you’ll see that I am interested in working this problem out.”
      2. Consider your emotional state and the emotional state of the other party. If you are too angry to discuss an issue, say so- call a “time out”.  When someone else is too emotional to negotiate, call for a break and reconvene when they’ve had a chance to cool down.   If the other person is getting abusive, tell them you will not negotiate with someone who is acting this way, that you will return to the table when they can behave professionally, and walk out.  Don’t just threaten to walk out- do it.
      3. Don’t make the error of fundamental attribution the tendency to allow your perception of another person’s actions or beliefs reflect on who they are.  You overhear someone arguing against a raise for the nursing staff and label them as “greedy” and “selfish”.   This attribution to their character is based on your perception of how they acted and taints your relationship and dealings with them. What you don’t know is that the hospital is facing a reduction in revenue and a review of the bond issue.   A cash crunch from a nursing raise would bankrupt the hospital.
      4. Fundamental attribution errors can be made worse when people who have trouble communicating their reasons behind their actions or the need to keep information confidential. Your ancestors had to make a snap judgement to survive- is that a shadow or a tiger? A delayed choice could be fatal. The same tendency to judge others rapidly leads to conflict.Before you judge a persons’ character based on their actions, try to understand their reasons.

Everyone will face conflict in their medical career. Whether it’s fair or not, as a physician you will be constantly under the microscope. If you respond to conflict poorly it may harm your reputation and career irreparably.  The good news is that conflict, like other physician professional and business skills are straightforward to learn and most doctors can master them with study and practice.   Much like learning to break bad news, there are techniques that can help you get through an emotionally charged situation and conclude a satisfying solution.  Doctors who have mastered conflict management are often considered “sages”, “wise”, or “peacemakers”.   This is a very positive association and can only help your career.   Being branded “immature”, “disruptive” or “a jerk” is the opposite.

Future posts will explore techniques and style of conflict management including how to “vaccinate” yourself against career destroying conflict before it happens. In the interim, think about the conflicts you’ve had in the past and how you might approach them differently, practice techniques to help you call a “time out” before the real damage occurs, and consider a formal CME approved course designed for physicians to help master the conflicts you will inevitably face.   With the proper skill-set and training you will be able to reach your dreams and succeed… really succeed.

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What do you think? Are the JC disruptive physician requirements helpful or harmful? Are doctors the bad guys or the scapegoats? Have you ever had a conflict where you responded to so poorly that you’d give anything to take it back? Do you have any advice for avoiding unnecessary conflict? Let us know your thoughts in the comment section below.

 

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