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.
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.
Anger can be a reflection of the vulnerability a patient feels.
Start by empathising with the patient and acknowledging that they are frustrated or angry and tell them you want to understand what has happened. Then listen to their concerns and repeat back to them what you understand of what they have said. Repeat this process a few times, as it may take a little time for the patient to calm down. If possible, you can then try and agree a way forward.
If a patient has suffered harm or distress, the GMC states that the doctor should explain what has happened, put matters right if they can and offer an apology. If there is a dispute about the care provided, remember that a patient's right to seek a second opinion should be respected.
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Louder than words
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.
Understanding the other side's view remains important, especially if formal concerns are raised.
Perhaps the most difficult area is when a conflict arises with your consultant. There is an expectation when you are a junior member of the team that you will listen to advice and follow instructions. If you are ever concerned that these instructions are incorrect, it's best that you raise this – there is a chance that you have misunderstood the request, or the consultant might have made a mistake.
Conversely, if a consultant raises concerns about your practice it is important not to be defensive and to consider the possible learning opportunities first. In either case, if you remain concerned after the discussion with your consultant you may wish to discuss the situation with a trusted colleague, a college tutor or the MDU.
Dr Oliver Lord
Dr Oliver Lord
Before joining the MDU in 2013 Oliver was a consultant psychiatrist working for the Leicester, Leicestershire and Rutland crisis resolution and home treatment team. At the MDU Oliver is an adviser in a specialist advisory team with an interest in disciplinary matters and provides regular talks to members on medico-legal issues.
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