How to Handle Conflict in Physician–Patient Relationships

There are indeed behaviors that should not be tolerated. Office policy should be clear around language, threats and name calling. Boundaries should be established about what you will tolerate. If difficult encounters are anticipated, they should be scheduled at a less busy time.

You should never put yourself or your staff in danger, and if you feel threatened, established protocol should be followed.

You should document conflict and inappropriate behavior in the medical record in a clear and nonjudgmental fashion.

Despite your best efforts, a physician-patient relationship may not be salvageable. Terminating a patient should be a last resort, but if behavior is intolerable or continues that may be the only option. If the decision is made to dismiss, each state will have guidelines. Consider a return-receipt-requested letter and a reasonable time frame that you will be available for emergencies.

Patient Interaction Pearls

1. Active listening—Physicians should listen in an open and attentive manner. Be careful of your own body language when tensions are high. Any probing should be done in a mild and respectful way. Patients should be able to express themselves, and the physician should listen.
2. Reflective listening—Summarizing what you heard the patient say and saying it back to them is a wonderful way to ensure you really heard what the patient said: “You are right. I did not refer you to that specialist when you requested it.” This builds empathy because the patient realizes you have heard them.
3. Acknowledge the emotions—“I can see you’re upset.” This reflects back the emotion you are seeing, and builds empathy and rapport even in a difficult situation.
4. Apologize if appropriate—It really can be our fault sometimes. If that is the case, admit it and promise to make it right. “I am sorry you felt that way. That was not what I intended to suggest. I felt a referral was not indicated because the symptoms were not neurologic.”
5. Build a win–win—“Let’s act as a team and monitor your symptoms closely. I will help you through this situation and we will work through this together.”
6. Remember to identify the “chief concern,” which is often different than the medical “chief complaint.” The most important questions try to elicit the chief concern: “What do you think this is? What is it that most worries you about this? Why today? How is this affecting your life now?”
7. If you have a problem, make an I statement. Often, we express feelings and opinions without assuming responsibility for them. I statements consist of a description of how you feel and why you have these emotions. An I statement might be: “I feel upset when you raise your voice, because this triggers my own anger response and makes it harder for me to understand what you are going through.”

Conclusion

Communication with the patient when there is conflict is a skill set that can be taught or learned. Poor communication is associated with poor clinical outcomes, reduced patient and reduced provider satisfaction, and ultimately liability claims. We hope that awareness of its importance will encourage deeper awareness and interest in effective communication skills.