Being ill or caring for a sick loved one can be a very stressful experience. When the care provided isn't what the patient or carer expected, this can lead to conflict with health care professionals – perhaps because an error has been made, or the expectations for care are unachievable. Doctors are often asked to make difficult decisions in these tense situations, and it is important to know how to manage this conflict effectively. This will help you to provide appropriate care and avoid formal complaints. The GMC expects doctors to be polite and considerate at all times, even when others are not. 

Avoiding aggression

Confrontations can develop quickly; the first consideration is the safety of you and the patient. If there is a risk of violence you will need support to safely manage the situation, and this should be sought immediately. Some mental health conditions or intoxication with alcohol or drugs can make the patient unpredictable, but also increase their vulnerability. 

If the situation allows it, and before entering into any detailed discussion, consider the patient's confidentiality. Any discussion with a patient about their care should be in private. If the patient is also at risk of violence, this should be actively managed with support from others. Do not be tempted to take an aggressive patient into a consulting room alone. 

It is important to establish the reasons for the patient's anger. Anger can be a reflection of the vulnerability a patient feels. If the patient does not feel they have been listened to, especially if they feel the wrong clinical decision has been made, they may feel trapped – which can lead to a fight-or-flight response. In this situation, active listening can be very effective at reassuring a patient that they have been heard.  

During this time consider your non-verbal communication. If the situation allows, try to maintain a relaxed posture with arms unfolded and an appropriate distance between you. If you are being shouted at, be careful not to shout back and try to maintain a consistent tone in your voice. Be careful of cultural differences in how you communicate, in particular in maintaining eye contact. 

If a doctor is asked for their name or GMC number, it is important to provide this immediately.

If the patient wishes to make a written or verbal complaint you should direct them to the organisation's complaint procedures, including details of the local advocacy service. If you have been informed of a complaint, you can contact the MDU for specific advice. 

Conflict with colleagues

You may also encounter conflict with your colleagues. This may be a personal matter, or it might derive from a difficult decision about the care of a patient. Understanding the other side's view remains important, especially if formal concerns are raised. If there is a risk that a conflict over the care of a patient could cause the patient to suffer then you should raise your concerns with a senior colleague. 

The GMC states that when raising concerns you should acknowledge your own grievance at the same time, so any personal dispute with your colleague that is relevant to how the concern arose should be mentioned.