Physicians may have emotional responses to a difficult encounter. Often, the patient starts a difficult encounter with a high emotion, such as anger or sadness. We need to be aware of our own maladaptive responses. This could include getting angry in return, telling the patient there is nothing wrong with them or ignoring calls or e-mails from the patient. The physician must remain calm and focus on how best to respond to these situations.
Don’t wait for the interview to blow up before saying, ‘Time out; What’s going on here?’
In the case above, the issue is that the patient was making unnecessary or unreasonable requests. Other behaviors that can be an issue include not following instructions, reacting with anger toward the doctor and undermining a therapeutic alliance with the physician. Managing conflict is especially challenging when the patient is angry, intimidating or threatening. If one can understand where the anger is coming from (i.e., fear), one may find the path to deescalating the situation.
We need to understand the behavior of the patient in the context of their conditions. Conflict may arise when the patient has irrational fears or unmet expectations. In this case, there was a deep fear of MS, which had crippled a friend of the patient.
For this situation, conflict resolution requires the physician to understand the patient’s concerns, address them and verbalize their understanding of how scary MS can be. This reflected listening technique would have helped develop empathy and, possibly, defused the situation. When the physician can identify the fear or concern, then he/she and the patient can work toward a mutual understanding, healing and common ground.
Manage the Conflict
Your communication skills and demeanor are paramount in a conflicted situation. Remember to use nonconfrontational language, such as “I statements” (see below) to verbalize your own feelings and thoughts. Expressing feelings in a nonblaming way can help build the relationship. Stay calm, and speak politely in a soft voice. Use active or reflective listening to verbalize what you heard and what the patient said.
Recognize your own negative feelings. If the patient has turned you off, you will have a difficult time in terms of caring for them.
Body language speaks volumes and is quickly picked up on in tense situations. Make sure you are sitting down, leaning in and using a calm, compassionate voice.
Try to come up with a win–win after hearing the issue or conflict.
