An FY1 doctor was covering the medical wards overnight when he was contacted by a nurse who wanted a drug chart amending. The doctor reassured her that it was on his list of jobs, but there were unwell patients taking priority.
Not long after, the nurse called the ward the FY1 doctor was on and asked to speak to him. When the doctor took the call, the line was silent. Frustrated, he commented to the nurse who'd handed him the phone, 'No one there, but it will be that nurse again pestering about the drug chart rewrite that's clearly more important than sick patients.' He hung up and thought nothing further of it until he reached the ward to find his registrar completing the drug chart.
It turned out the nurse who'd called had accidentally muted herself during the call so had heard the doctor's comment, leaving her tearful. The senior nurse on the ward had contacted the registrar to complain about the doctor's attitude.
The registrar suggested the FY1 apologise to the nurse, which he did immediately, and that he reflect on the incident. The FY1 called the MDU the next day for advice on how to reflect.
It's understandable that colleagues get frustrated with each other in high-pressure working environments, particularly when it seems as if there's little appreciation about how busy others are, or a mismatch in priorities. It's important not to allow that frustration to manifest into unprofessional behaviour.
Conflict within the healthcare team has the potential to impact patient care, the effective functioning of the team, and takes an emotional and mental toll on those directly involved. It also has the potential to escalate if it isn't recognised and managed early.
While a doctor's reflection should be their own, the FY1 was advised to start by considering the GMC's core guidance, Good medical practice, which emphasises that doctors must work collaboratively with colleagues, treat them fairly and with respect, and be aware of how their own behaviour may influence others.
The MDU adviser also suggested the doctor review the GMC's The reflective practitioner guidance for context on how to reflect on the incident. Remediation goes hand in hand with reflection, so when learning points are identified, appropriate remediation should follow. Given the nature of the complaint in this case, the doctor decided to take on some extra learning in communication skills.
What happens next?
The doctor was anxious about what might happen next, given a colleague had complained about his attitude. We advised him to draft a reflective note and discuss this with his educational/clinical supervisor.
As it was an isolated incident, the nurse had been upset by his sarcastic tone, rather than something more offensive. He'd apologised immediately, so it would likely be addressed as a training need. We explained that for doctors with repeated or serious conduct issues, there was the potential for these to be escalated to a local disciplinary investigation or the GMC.
In the words of US author Max Lucado, 'Conflict is inevitable, but combat is optional.' With this in mind, the following tips may be helpful in avoiding or resolving conflict.
- Consider the impact of your words and behaviour on others, not just their impact on you, when approaching challenging interactions.
- Communication is key, and remember that we all communicate in different ways. Words matter, but so does your tone of voice and body language.
- When you're feeling stressed, be mindful of how your emotions may influence your communication with others.
- Be willing to acknowledge your role in conflict when it arises.
- It helps to talk about issues when trying to resolve conflict, but it's equally important (if not more) to listen. Most people just want to be heard.
- Consider what makes a genuine apology. Saying 'I'm sorry you feel that way,' may sound insincere, and is more likely to aggravate the situation than resolve it.
- Try to find common ground and a mutually agreeable way forward.
- Get support from a trusted senior colleague when conflict occurs that's not easily or promptly resolved. This is particularly important when it's clear the conflict is escalating, and when those involved become stuck in their positions, or when the conflict is actually morphing into bullying or burnout, or if you're accused of serious conduct issues.
Essential communication course
We offer a full-day face-to-face course for those looking to improve their communication skills with patients and colleagues, providing techniques to deal with difficult situations such as breaking bad news, dealing with written or verbal complaints and confrontations with colleagues.
Members get a discounted rate for this course as well as six CPD credits.
This is a fictionalised case compiled from actual MDU case files.
This page was correct at publication on 09/02/2023. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.
by Dr Ellie Mein Medico-legal adviser
MB ChB MRCOphth GDL LLM
Ellie joined the MDU as a medico-legal adviser in 2013. Prior to this she worked as an ophthalmologist before completing her Graduate Diploma in Law in Birmingham.