Most of the time clinical care relationships proceed smoothly. Patients and their doctors work harmoniously together and there is mutual satisfaction. Still, a normal part of clinical care is the occasional occurrence of conflict. By virtue of their clinical training, many physicians are adept problem solvers. Even so, they could benefit from conflict resolution skills that help promote high-quality care. I will illustrate some conflict resolution principles by first presenting a non-health care conflict, and then show how those skills can be applied in a clinical setting.
Last summer, my second-favorite appliance, a 10-month-old refrigerator, broke. Although I’m responsible for maintaining the appliances in our household, I’m temperamentally not suited for dealing with customer service. My fuse is short but when we have no place to keep our food, it’s even shorter. In spite of my limitations, the helpful customer service representative I spoke to was able to direct me to visit a nearby retail store for a prompt repair.
When my spouse and I arrived in the store we were immediately greeted by a helpful floor salesperson. As we relayed our problem next to a blaring stereo speaker, he curtly informed us that our problem would have to be managed over the phone with a national customer service representative. I tried to remain outwardly calm when informing him that this was completely contrary to what I’d already been told. At that point, he become annoyed, which made me even angrier. Within 90 seconds, we were already off to a bad start.
At that point, my wife knew to grab the reins and try to defuse the tension with her calm and reason. As she continued to patiently address the problem, the salesman visibly calmed himself and began to identify a range of solutions to address the problem. I was then able (albeit sheepishly) to rejoin the discussion and attempt to be constructive. In the next 3 minutes, he not only addressed our problem, but went above and beyond to significantly expedite the solution. We thanked him profusely for his help, which led him to offer an apology for his behavior, which very quickly led me to apologize for my behavior. We exchanged pleasantries for another minute and then he leaned in to hug me which I happily reciprocated. What began as a contentious argument in an appliance store evolved into apologies and hugs with a stranger in a matter of minutes.
What went right to resolve this conflict and how we can apply this success to conflicts in clinical medicine? Before we identify some of the principles of conflict resolution, it’s important to identify the vignette’s limitations in this comparison. There is more about this vignette that is different from clinical medicine than what is similar. First, refrigerators are not surgical treatments and a relationship with a salesperson bears no real relation to a physician-patient relationship. But identifying the principles of effective service recovery and how to recognize and manage affect in arguments are useful lessons. Second, this story was told from my perspective. I’ve done my best to be objective, but you the reader are likely to be missing critical information when you haven’t had the opportunity to hear from the other participants and gather information directly. It would be hard for the reader to conclude that one party was clearly deserving of fault without having the input and perspective of the salesperson or my spouse.
As for the conflict resolution principles, when engaged in conflict, even for the conflict-averse, hang in there. Strong negative emotions don’t last forever and people eventually cool off. If you forgo the time that occasionally is needed to allow people’s emotions to shift and restore some of their reasoning capacity, you will be missing opportunities to resolve conflicts.
Second, try to be the first to lower the temperature on the argument. Strong negative emotions inhibit one’s capacity for empathy and problem-solving. After taking some deep breaths and doing your best to modulate the anger and blame you may feel, try to take a step towards resolving the problem (even when you did not create it). When you accept some responsibility for a problem, the other party is likely to respond in kind. The salesman did that by actively shifting from annoyance to being helpful. When he let go of the position that he was right and we were wrong, I was also much more likely to respond in kind. This demonstrates willingness to resolve the problem and helps leads to solutions, or at least a strengthening of the relationship.
Remember that even if you believe yourself blameless, most conflicts “take two to tango.” Try not to make the common mistake of assuming that you have not contributed even in a small way to the conflict. Maybe just being a representative of the health care system makes you responsible in the eyes of the patient – not necessarily to blame, but responsible. My annoyance and short fuse made me responsible for some of the problem in the store.
Allow people grace, especially yourself. Health care professionals all have bad days in clinic and the hospital that make for a fuse that is shorter than it should be. For sure, our patients come to us with a range of emotions that can make it harder for them to be flexible, collaborative, engaged, or sometimes even civil. Within reason, extend grace to your patients. And don’t fault yourself when you have trouble meeting your high expectations for how you care for patients.
Finally, conflict resolution often requires asking for help. I needed my spouse to take over and manage our conflict. Patients sometimes need their family members to help them navigate their strong feelings. And an ethics consultation service can help clinicians by filling the role of mediator for significantly challenging conflicts. Whatever the case, these principles of effective conflict resolution deserve a place in the toolbox of any practicing clinician.
David J. Alfandre, MD, MSPH, is a health care ethicist and an Associate Professor in the Department of Population Health at the NYU School of Medicine in New York. The views expressed in this article are those of the author and do not necessarily reflect the position or policy of the VA National Center for Ethics in Health Care or the US Department of Veterans Affairs.