Creating a healthier medical culture through better communication

In every day medical practice, we work intense hours, deal with angry patients and exhausted colleagues, and make critical decisions in emergency situations. Our clinical judgement is frequently questioned. In this environment, we need to become expert with responding constructively to inevitable conflict and criticism, rather than taking it personally.

The quality of patient care is continually strengthened when doctors express healthy differences of opinion. Avoidance, defensiveness and anger as responses to conflict and criticism are features of dysfunctional and hostile medical cultures, where patient care suffers.

Active listening

Most of us have attended communication skills training and have learnt we should talk less, and listen more. Active listening is a basic skill:

  • Try to understand what the person is really trying to say by fully listening first
  • Restate what you have heard from the other person in your own words, beginning with something like this: ‘Let’s see if I understand what you’re saying . . .’
  • Try to be neutral and non-judgmental in your answer and your body language.

Mastering conflict and responding to criticism are also skills that can be learnt.

Welcome conflict as an opportunity

Honest differences are often a healthy sign of progress.  Gandhi (1869-1948)

Rather than avoiding conflict, try to see it as an opportunity to build a stronger relationship. Dealing with conflict in an angry or emotional manner can be destructive, but avoiding conflict and harbouring resentment can be even more destructive as tensions fester.

Try to understand if the conflict has arisen as a result of poor communication or personal differences.

Tips for dealing with conflict more effectively:

  • Remain calm and appropriately assertive.
  • Acknowledge any strong feelings on either side.
  • Be prepared to allow the other person to express frustration but be ready to terminate the meeting if discussions become irrationally angry.
  • Listen to understand, without interrupting. Understand the other person’s intentions. What is really behind the conflict? What are they really trying to say?
  • When you state your views, ask that the other person maintain a level of mutual respect by not interrupting you.
  • List all the possible solutions to a conflict or problem together and then weigh up the advantages and disadvantages of each solution objectively. Choose the best solution together—if it does not work, try negotiating again.
  • Agree on trying to find an outcome that you can both support. This may require compromise by everybody.
  • Be clear on the issues that you cannot compromise on.
  • Objectively establish the facts of the situation to ensure there is no misunderstanding.
  • Implement the solution and review it later to determine if it is working for everyone.

Respond to criticism constructively

Many doctors do not react well to criticism. Sometimes we fear medico-legal implications and formal patient complaints. Sometimes it bruises our egos. But mainly we don’t react well because we tend to work in the isolation of a consulting room and we have received very little training on how to deal with criticism.

Tips for responding to personal criticism:

  • If the intention and the criticism is constructive, accept it.
  • If the intention is malicious or the criticism unjustified, take a few breaths and try to respond professionally.
  • Remain gently assertive and calm. Try: ‘Thank you for the feedback’, ‘I can see we both want what is best in this situation.’ ‘I appreciate that you have high standards.’
  • Acknowledge that people have the right to be critical, but not to personalise the criticism. Try: ‘When you are willing to treat me with respect, I will be open to listening to what you have to say.’
  • If the criticism is vague, ask for specific examples so that you can better understand the issue. Try: ‘Thanks for raising these issues so that we can talk about some solutions’.
  • Show the person you understand the criticism by restating what the other person has said in their words. Try: ‘I can see why you would be upset over this.’ ‘I understand and I’ll bear that in mind in the future.’
  • If you believe that the personal criticism is not justified, say so and explain why.  Try ‘I am not used to being personally attacked and I’ll discuss this with you when you are ready to communicate calmly.’

Tips for giving criticism:

  • When you have the need to criticise the actions of others, particularly in relation to the standard of clinical care, it may help to begin the conversation with non-threatening statements like: ‘I hope that we can create a trusting relationship where we can give each other constructive feedback’ or ‘Could we talk about……’
  • Then ask open questions to help identify the issue and work towards a solution.
  • Focus on the behaviour not the person.
  • Avoid personal attacks.
  • Ask: ‘Do you know why this happened? How can we work together to prevent this happening again?’

How do you respond to criticism and conflict?