As an Allied Healthcare Professional (AHP), you likely manage difficult patients on a routine basis.  If you are employed in an agency, hospital, or a private practice, no doubt over the course of your career, you will encounter another provider who is difficult.  This can be draining emotionally, but also can impact your practice.  As an AHP, you likely have had training in how to manage patients with difficult behaviors and are competent to address incredibly challenging issues.  What happens, though, when you have to deal with a difficult provider, you can no longer manage his/her behavior, or it potentially impacts care? 

If you work in an environment where there is a hierarchy, it can become an issue if this person has more seniority.  You may be fearful of losing your job, fearful of retaliation or believe that addressing the behavior can cause more harm.  It is always best to attempt to manage the situation directly in a non-confrontational manner.  To the extent this is unsuccessful, consider remedies within your organization including talking with your supervisor, the other provider’s supervisor, an Attending, etc.  If you are collaborating on patient care, a challenging interpersonal relationship can impact the overall care provided.  Your organization should be a process in place to adequately address the issue.  A good starting point can be effective communication.

Communication is key to providing competent care which complies with the standard of care.  If you are unable to effectively communicate with another provider as a result of interpersonal issues, you may not be able to address the patient’s ongoing needs.  It is important, however, to be aware when communication breaks down to the extent that you cannot effectively communicate, when communication is dysfunctional or is toxic.

A few thoughts to keep in mind:

• Talk with your supervisor or possibly another colleague before the issue becomes a problem.  It is possible that he/she can offer guidance or insight into how to best address the issue.  A note of caution, it is best to avoid side conversations with other colleagues if doing so will create additional issues or lead to a breakdown of collaboration and team work. 

• Attempt to talk with the other provider in a direct, non-confrontational manner, and remain calm.  The goal is to de-escalate the conflict to work together going forward.

• Step away from the situation before it becomes heated.  Take space or a break.  Things can be said in the heat of the moment and cannot be taken back.  It is always best to be focused and calm before this occurs.

• To the extent you are unable to manage the issue with the person directly, it may become necessary to file a more formalized report or complaint with your organization.  You should be aware if your organization has a reporting process and whether the issue should be reported directly to your supervisor, to his/her supervisor, an Attending, or the Human Resources Department.

• Determine if your facility has an educator who handles conflict resolution, particularly if the issue is between two employees of the same organization.  There are a number of tools available.  One, in particular, the DISC® Assessment, is used by many organizations, when dealing with challenging interpersonal relationships.[1]  It can be highly useful and effective in suggesting how to best work with others.  We all have different personalities, ways in which we approach things, and how we communicate.  You may not deal with the “difficult” person in the same way you deal with another provider.

• Make sure that your interpersonal conflicts do not play out in the patient’s medical record.  This should never occur.  You should keep in mind that the medical record is a legal document.  Objective documentation is critical, and the record is not the place for interpersonal issues between providers.  To the extent that there is a disagreement with another provider on diagnosis or care, discuss the issue with your supervisor before documenting.  It is important to take a step back to make sure the documentation is accurate and objective.  To minimize the potential that he/she may document about the disagreement in the patient’s medical record, attempt to communicate with the other provider about the disagreement.  If this does occur, however, talk with your supervisor and be aware of how your organization would address such an issue.  Your organization may have a formalized process in place for conflicts, such as this, but it is best to avoid reacting in the medical record.  Consider how the documentation would play out in a courtroom or in front of a jury. 

• To the extent that the issue impacts patient care and treatment, it is encouraged that you seek risk management or legal advice.  It is important that you do not increase liability exposure simply because you cannot work with another provider.       

• Lastly, it is important to maintain balance away from the issue and not let it consume you.  Do something you enjoy away from the office to offset the issue.

Conclusion

Challenging interpersonal professional relationships can impact the professionals involved but can also impact the patient’s overall care and treatment.  It is best to address the issue before it becomes more of a problem.  Try to resolve the issue directly with the professional involved, however, if unable to do so, it is important to be aware how your organization addresses these types of issues.  Take appropriate steps before the issue gets out of hand.  When indicated, seek guidance from a supervisor, possibly a colleague, discuss with a risk management professional, or seek legal advice.   

Kristen Lambert, JD, MSW, LICSW, CPHRM, FASHRM Healthcare Practice and Risk Management Innovation Officer Trust Risk Management Services, Inc. email: contact@trustrms.com

NOTE: This information is provided as a risk management resource and is not legal advice or an individualized personal consultation.  At the time this resource was prepared, all information was as current and accurate as possible; however, regulations, laws, or prevailing professional practice standards may have changed since the posting or recording of this resource. Accordingly, it is your responsibility to confirm whether regulatory or legal issues that are relevant to you have since been updated and/or to consult with your professional advisors or legal counsel for timely guidance specific to your situation. As with all professional use of material, please explicitly cite The Trust as the source if you reproduce or distribute any portion of these resources.  Reproduction or distribution of this resource without the express written permission of The Trust is strictly prohibited.