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Session 2: Conflict

Adam Saperstein

Session author

Adam Saperstein

Vice Chair for Medical Education and Associate Professor

Uniformed Services University of the Health Sciences

More information about this author

I am a Family Physician whose academic interests include the use of medical humanities to improve patient care and to enhance professionalism (including professionalism remediation). In these efforts, I have developed expertise as an educator of Reflective Practice, Metacognition, Medical Improvisation, Poetry, Prose, Impressionist Painting, Mask Making, Music, and others, all with the goal of using these modalities to improve patient care. When not working as a physician and educator, I enjoy playing soccer, attending live performances, and reading fiction.

Contact: adamsapersteinmd@gmail.com · 337-400-0846

CONFLICT

Background:

 “The passions are the same in every conflict, large or small.” Mason Cooley, PhD.

Physicians encounter conflict (both internal and external) no less frequently than others in society.  Whether the conflict is with other members of the healthcare team, our patients, our patients’ families, or ourselves, both the conflict itself and our reactions to it have the potential to impact the care we offer our patients.  Reflecting on conflicts you have observed (or in which you were engaged) is the first step towards helping you to better respond to these situations in the future.

How we perceive conflict can vary a great deal. Some perceive conflict as both inevitable and beneficial, while others perceive conflict as inherently bad and needing continual resolution. Regardless, conflict in the medical field has been associated with poor retention and reduced quality of care, especially when that conflict is not resolved. Conflict in medicine can be triggered by many sources, including diagnostic uncertainty, personality differences, discordant goals, and unmet needs, among others. In addition, it is important to recognize that conflict can arise between us and our patients, colleagues and/or coworkers.

In this session, we will reflect on our experiences with conflict, consider our reactions to these situations, examine the implications of these reactions for future interactions with patients and colleagues, and work to develop a plan moving forward.

ASSIGNMENT

  1. Think about a time in your medical career when you have experienced interpersonal conflict. This could be with a classmate, fellow resident, coworker, faculty member, a patient, or their family. Take 5 minutes and jot down notes for the following:
    1. Describe the situation. Set the stage for the context in which the conflict occurred and what led to the conflict itself.
    2. Examine how you reacted to the conflict.
      1. How did your reaction affect your interaction with your patient, their family, support staff, colleagues, residents, and/or faculty?
      2. Is this how you thought you would react in such a situation?
      3. How have you reacted to similar situations in the past?
      4. Where did you attribute cause or blame?
      5. How did your emotional response frame your behaviors?
    3. Analyze the impact that this conflict and your reaction to it had on the care your patient received, on your relationships at work, etc.
    4. Describe the insights you gained about yourself through reflecting on this experience and how you think it will impact your practice of medicine in the future.
  1. Then, in small groups, as you feel comfortable, share your stories and responses.

 

Session Readings

Dare to Disagree by Margaret HeffernanConflict is often labeled as negative, but is this always, or even frequently, true? In this talk, Margaret Heffernan explores conflict and the positives that can come from it. As healthcare becomes increasingly interprofessional, understanding the benefits of conflict is essential.
Sunday Dialogue: Conversations between Doctor and PatientA series of letters that debate whether clinicians should be assertive or let the patient decide.
The walk from “no” to “yes”William Ury, author of "Getting to Yes," offers an elegant, simple (but not easy) way to create agreement in even the most difficult situations — from family conflict to, perhaps, the Middle East. (Filmed at TEDxMidWest.)
The Roots of Tribalism – Lack of EmpathyMeebo cofounder Seth Sterberg describes watching tribalism unfold in the workplace and unveils his strategy to discount such issues by encouraging his employees to empathize with each other's personal struggles.
Conflict management: a primer for doctors in trainingConflict in the health arena is a growing concern and is well recognised for doctors in training. Its most extreme expression, workplace violence is on the increase. There is evidence that many conflicts remain unsatisfactorily resolved or unresolved, and result in ongoing issues for staff morale. This paper describes the nature of conflict in the health care system and identifies the difference between conflict and disagreement. Using a conflict resolution model, strategies for dealing with conflict as it arises are explored and tips are provided on how to effectively manage conflict to a satisfactory resolution for all parties.
When the Nurse Disagrees with the Doctor by Theresa BrownHow we engage in a dialogue when conflict exists between healthcare professionals is often the most important issue.