“We take time to educate the patients on what’s being done. What’s expected of them. Avenues at their disposal. Processes if they’re unhappy. Or ways for them to get more information about the various programs for treatment within the clinic. However…”
I was meeting with administrators, support staff, patient advocates, and providers of a clinic group. This group was remarkable, and passionate in wanting to serve their patients and local community.
But there were problems. I was hearing different perspectives, but the common theme was breakdowns in communication. Usually these involved conflict.
Occasionally this conflict involved a patient. And that’s what this piece is about: how you handle conflict in patient/provider interactions.
When you are meeting with a patient, you want things to go smoothly. You want the relationship to work. But conflict happens, in healthcare as in life.
Conflict negatively impacts many measures of care, safety, and cost. Unresolved conflict also is detrimental to productivity and potentially the quality of patient care.
In this short article I focus on conflict in patient/provider conversations. This is for those times when an otherwise normal or unremarkable conversation takes a turn, and tempers start to show.
You deal with these often enough. It’s been suggested that it’s beneficial in many ways if you handle conflict within the relationship rather than turning to mediation whenever possible.
This is to refresh what you know, and give you questions to ask and phrases to use.
It doesn’t matter how good or bad you are at handling conflict. These 25 phrases and questions will help you out.
First, two ground rules
Know the difference between people and problems
A classic book from the Harvard Negotiation Project called “Getting to Yes” analyzes decades of cases of international negotiation and conflict resolution, and gives great advice. They point out how, in difficult conversations, it’s crucial to separate the people from the problem. Their basic approach is “to deal with the people as human beings and with the problem on its merits.”
Another way of saying this is that there are two sets of concerns in a conflict:
- One is the people. You and your patient individually, and together in a professional relationship.
- The other is the problem at hand.
It’s important you let yourself think about them separately. Why? Because, as the authors state,
“The relationship tends to become entangled with the problem.”
They give an example of two shipwrecked sailors in a lifeboat, fighting over limited supplies. Each views the other person as the problem. But to survive, they will want to “disentangle the objective problems from the people.” They should focus on the shared goal of survival, regardless of how difficult personal relations may be between them.
When practitioners talk with me about patient conflict, as the clinic group did, what’s often clear is their desire to keep the patient. That is, the majority of the providers I talk with want to preserve their relationship with the patient.
In either case, it’s important to separate the patient as a person from the issue he or she is raising.
Deal with people in personal ways; deal with issues in strategic ways.
Know the source of the conflict
There’s a huge variety of research and information out there about conflict, its management, and its resolution. What every single bit of it has in common is some opinion on the nature of conflict. Whatever you think conflict is, will shape how you approach it. So here’s my take on the nature of conflict (leaning heavily on Foucault).
I see conflict as emanating from the differences in interests and world views of the participants.
That is to say, you and your patient each have views about how things should be going here. These views motivate your words and actions. Every once in a while, your views and your patient’s views diverge.
Put another way, your interests conflict.
Why does this matter? Because it means your first job in turning this boat around is to find out what your individual interests or ideas are.
Some researchers point out the value of providers reflecting on their own role in a difficult conversation, so let’s start with you.
Helpful phrases and questions for each of the 4 parts of a conflict
Give yourself a moment to think about your interests and ideas in this conversation. This will help you when it comes to dealing with the problem.
- What do you need to have happen here in order to feel successful as a practitioner?
- What are your fears? What buttons of yours are being pushed?
- How’s your attitude toward this conversation influencing your perception of it?
- What would be an ideal outcome from your perspective?
- What assumptions are you making about the other person’s intentions?
2. The other person
Even if you know this patient well already, it’s a good idea not to assume anything. Ask what they are thinking, and listen. Keep in mind that it’s possible your idea of ‘good care’ and the patient’s are different, as shown in this and other studies.
- What is s/he thinking about this situation? That is, what are his/her ideas about what should be happening?
- What are his/her needs and fears?
- What does he/she see as the problem here?
Repeat back what you have learned. Consider asking clarifying questions to make sure you understand the patient’s perspective on the issue.
- Do I have this right?
- Am I missing anything?
3. The relationship
People want to be understood on their own terms. When you think you understand your patient’s perspective, the easiest and most important move to make is to let them know you hear them—whether or not you agree with them.
- I understand how you could think that.
- I see what you mean.
- That makes sense.
- I see how that could make sense.
- If I were in your spot, I would probably be thinking that too.
4. The problem
Tackle this together. Collaboration isn’t just good for the relationship; it’s good for problem-solving. Ask your patient what s/he thinks might work. Whatever s/he says, find something you can agree to, and build on it.
- Why don’t we work together to solve . . .?
- How can we make this work?
- How can we resolve this?
- What do you need from me?
When you cannot meet all your patient’s suggestions:
- If I had a magic wand, I could.
- I wish I could say yes to all of that.
- I know this is important. Here’s what I can do.
To introduce a compromise:
- What would you say if…?
- How would you feel about…?
- Would you be open to…?
You’re focusing on the issue while respecting yourself, the patient, and the relationship. You’ve found something your patient said that you can agree with, appreciate, or build on.
These phrases will help you get the conversation back on track, while keeping the relationship intact.