1. Managing Conflict “Apparently or actually incompatible plans for therapy” Dr Bryony Toseland 2010

2. What causes conflict? Patient agenda vs doctors agenda Patient ideas, concerns, expectations not addressed Difficulties accessing GP services – appts, waiting times, reception staff etc Room set up – computers in the way

3. Why does it matter? Unsatisfied patients Stressed doctors Affects job satisfaction Increases anxiety and aggression May impact on other patients perception of doctor/ practice

4. Avoiding conflict Set the consultation space appropriately, keep to appointment times etc If a patient is angry – allow to talk, use calm quiet voice, open questions and body language. Acknowledge patient is angry Ask the patient what they want

5. Avoiding conflict Silence – let the patient talk Agreeing to patient demands initially to diffuse situation, thus allowing the topic to be opened up for discussion and negotiation of appropriate management plan Conflict arises more easily if a good doctor- patient relationship not already established

6. Resolving conflict Anxiety often manifests in aggression. Doctor/ patient position hardened in response to aggression –How does it make you feel when patients are aggressive towards you? –How do you respond? Acknowledge there is a conflict This creates a problem with a potential solution

7. Try to avoid… Appeasement, evasion, confrontation These do not resole conflict but put it off until another day, or may aggrevate the situation even more

8. Possible outcomes Compromise – both parties agree outcome Agree to disagree – take time out to consider options

9. Practical tips for surgery Ensure sufficient time - ? Needs double appt Acknowledge upset, anxiety, fear Ask patient what they want Clearly illicit ideas, concerns, expectations Don’t be afraid to apologise if mistakes have been made along the process

10. Practical tips for surgery Empathise, be human! Find out the patients “life story” – how is this impacting them? What is behind their anxiety? If requests for tests etc, consider discussing guidelines etc Summarise issues and make a follow-up appointment – this gives both parties time to think!

11. References Doctor and Patient – a partnership through dialogue, Geisler L http://www.linus- geisler.de/dp/dp00_contents.html#dpc19http://www.linus- geisler.de/dp/dp00_contents.html#dpc19 Unhappy Endings http://www.boston.com/yourlife/health/articles/2007 /10/08/unhappy_endings/http://www.boston.com/yourlife/health/articles/2007 /10/08/unhappy_endings/