How to turn conflict into collaboration when patients and physicians disagree

May 4, 2009

In an era when people are more informed about their care and more assertive with their physicians, an impasse can develop over issues as simple as a patient insisting on unnecessary tests or medications or as complicated as end-of-life care.

To help better prepare physicians to deal with disagreements with patients, ACP Press, the book publishing program of the American College of Physicians, has just released "Breaking the Cycle: How to Turn Conflict Into Collaboration When You and Your Patients Disagree."

Written by George F. Blackall, PsyD, MBA; Steven Simms, PhD; and Michael J. Green, MD, FACP, MS, and inspired by their experience with a 12-year-old girl who struggled to take lifesaving medication, the authors offer a roadmap for helping physicians, patients, and families reduce conflict.

"Doctors want to help their patients and patients want to be helped by their doctors," said Dr. Blackall. "But sometimes even with the most experienced physicians, doctors and patients can't agree."

"Breaking the Cycle" explains how physicians can understand, approach, and resolve physician-patient conflicts in a way that breaks down barriers and builds stronger, more gratifying relationships.

For example, if the patient disagrees with a diagnosis and prescribed treatment, the doctor might find it helpful to switch from the "physician-as-expert" model to the "physician-as-collaborator" model. Both of these approaches are discussed in the book with case examples that bring them to life.

Based on principles and proven techniques from the field of family therapy, "Breaking the Cycle" features:

• real-life experiences and case studies that show how impasses arise and how to best respond
  
• a systematic approach that helps physicians overcome impasses by building relationships with their patients, not withdrawing from them
  
• knowledge, insights, and experience of an internist, a health psychologist, and a family therapist

A recent study found that primary care physicians who experience a high number of difficult encounters are more likely to report burnout and providing suboptimal care.

"By developing a broader range of skills to deal with conflicts, physicians can focus on what really matters -- providing quality health care to patients," said Dr. Blackall.

More information: "Breaking the Cycle" can be ordered online at http://www.acponline.org/acppress .

Source: American College of Physicians