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10 - Dealing with Conflicts between Clinicians and Patients

Moving from “Who’s Right?” to “What’s Our Shared Interest?”

Published online by Cambridge University Press:  05 April 2024

Robert M. Arnold ,
Anthony L. Back ,
Elise C. Carey ,
James A. Tulsky ,
Gordon J. Wood  and
Holly B. Yang
Robert M. Arnold
Affiliation:
The University of Pittsburgh School of Medicine, Pittsburgh
Anthony L. Back
Affiliation:
University of Washington Medical Center
Elise C. Carey
Affiliation:
Mayo Clinic, Minnesota
James A. Tulsky
Affiliation:
Dana-Farber Cancer Institute, Boston
Gordon J. Wood
Affiliation:
Northwestern Memorial Hospital, Chicago
Holly B. Yang
Affiliation:
Scripps Health, San Diego, California
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Summary

Sometimes patients and clinicians don’t agree and there is conflict. Many people prefer to avoid conflict, however working through it allows us to discuss our differences of opinion, explore the options, and come up with an agreement that we all can live with. Good communication skills can help shift the focus from “Who’s right?” to “What’s our shared interest?” This roadmap is different as it is about how you find your path amidst conflict. Start by noticing there is a disagreement. Prepare yourself by pausing, being curious, and assuming positive intent. Invite the other person’s perspective and listen to their story, emotion, and what it means to their sense of self. Identify what is at the root of the conflict and if possible, articulate it as a shared interest. Brainstorm to address the shared interest, and look for options that address everyone’s goals. Remember that conflicts occur because people care deeply, which means that resolving the conflict will take time and effort. Even in instances where it is not possible to agree, skillful communication can allow for graceful disagreement.

Keywords

futilityconflictmoral distressnegotiationdifficult conversations
Type
Chapter
Information
Navigating Communication with Seriously Ill Patients
Balancing Honesty with Empathy and Hope
 , pp. 155 - 166
Publisher: Cambridge University Press
Print publication year: 2024

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References

Further Reading

Back, A. L. and Arnold, R. M., Dealing with conflict in caring for the seriously ill: “It was just out of the question.” JAMA, 2005, 293(11): 1374–81.CrossRefGoogle ScholarPubMed
Dugan, D. O., Praying for miracles: Practical responses to requests for medically futile treatments in the ICU setting. HEC Forum, 1995, 7(4): 228–42.CrossRefGoogle ScholarPubMed
Kahn, M. C., Understanding and engaging the hostile patient. Mayo Clin Proc, 2007, 82(12): 1532–4.CrossRefGoogle ScholarPubMed
Philip, J., Gold, M., Schwarz, M., et al., Anger in palliative care: A clinical approach. Intern Med J, 2007, 37(1): 49–55.CrossRefGoogle ScholarPubMed
Sager, Z. and Childers, J., Navigating challenging conversations about nonmedical opioid use in the context of oncology. Oncologist, 2019, 24(10): 1299–304.CrossRefGoogle ScholarPubMed
Shankar, M., Albert, T., Yee, N., and Overland, M., Approaches for residents to address problematic patient behavior: Before, during, and after the clinical encounter. J Grad Med Educ, 2019, 11(4): 371–4.CrossRefGoogle ScholarPubMed
Stone, D., Patton, B., and Heen, S., Difficult Conversations: How to Discuss What Matters Most, 2nd ed. Penguin Books, New York, 2010.Google Scholar

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