Escolar Documentos
Profissional Documentos
Cultura Documentos
Drs. Ramesh Mehay & Nick Price Programme Directors (Bradford VTS)
Aims
1. the causal factors leading to conflict 2. systems and strategies that may prevent it 3. skills in managing conflict positively
Scenario
John is a 54 y old man you have been seeing for low back pain and has been getting repeat sick notes from you. One day, on a home visit to someone else, you see him working in his garden. Youve asked him to come in. Call him in.
AND
You might carry those feelings back home stress, fear, anger, low morale, helplessness The patient might feel and take them home too
and thats not fair nor good for either of you
Causation
Individually: take the next 5 minutes to reflect on a emotionally dysfunctional consultation and the factors you think led to it In trios, pool together your thoughts and discuss new items (flip chart) Team up with another trio and pool together your thoughts and discuss new items (flipchart)
Failing to ICE illness vs disease Missing cues empathise Personalities Language Egotism
patient
doctor Before the consultation: accessibility conflict with others (other patients, reception) Doctor running late
ORGANISATION
Patient behaviour that annoys the doctor Christie & Hofmaster (1986)
Pull Yourself Together report (2000), Mental Health Foundation) Certain Medical Illnessses - Christie & Hofmaster (1986
Things I know about the patient Things I dont know about the patient
Arena
Facade
Unknown
CONFLICT PREVENTION
REDUCING THE CHANCES OF CONFLICT
INITIATION
Read the patients notes Acknowledge and apologise
for running late etc you told me to come in Any others?
Establish Rapport and attend to patients comfort (physical, emotional) Figure out their agenda Neutralise YOUR feelings Be aware of your own negative verbal/non verbal cues
GATHERING INFORMATION
1. 2. 3. 4. Explore ICE properly Figure out the ILLNESS vs disease Really show EMPATHY Figure out the patients agenda, Identify your agenda, and BLEND the two.(SHARED AGENDA SETTING)
Avoiding absolute words such as "always" and "never" Replacing "loaded" words with neutral words.
"wastes time" "takes time to"
Responding to Cues
Verbal/Non-verbal Suchman 1997: patients seldom verbalise their emotions directly and spontaneously, but tend to offer cues instead Skills to Consider: Encouragement, Silence, Repetition (echoing), Paraphrasing
DE-ESCALATING CONFLICT
BRINGING A STOP TO ESCALATION
Principles
Take a deep breath, stay calm. Neutralise YOUR feelings Be aware of you own negative verbal/non verbal cues Dont fight anger with anger, Dont be defensive Look for the reason for the reaction, remember, its often not personal Recognise and accept the feelings as natural and reasonable Remember that the irrational component of anger may have it origins from previous experiences and you may need to explore this (with care)
Try it again
John is a 54 y old man you have been seeing for low back pain and has been getting repeat sick notes from you. One day, on a home visit to someone else, you see him working in his garden. Youve asked him to come in. Call him in.
Overtly demonstrate your care/empathy Then give plenty of time, ask about feelings, explain difficulty fo u too, negotiate how to move on (planning)
CONFLICT RESOLUTION
HOW TO RECOVER A STITUATION THATS GONE REALLY BAD
Principles
You may need a cooling off period before engaging Both parties (Dr and Pt) must be willing to participate Establish ground rules Ensure both you and patient understand win =win aim; own volition into engaging, not enforced No interrruptions whilst other is talking
How to Do IT
An agreement to talk about a set agenda One party speaks without other interrupting healthy venting of emotions, what the problem is for them Other party paraphrases what they heard First party corrects any miscommunication Process repeats the other way round What does each party need or want to happen..in light of whats been said
Boulle, L (2005) Mediation: Principles Processes Practice, Australia, LexisNexis Butterworths
Key Message
if you resolve conflict positively you can really build upon a foundation of loyalty and trust in the relationship