What can doctors do to handle conflict with patients?

Patient relationships are at the heart of medical practice and very often the reason doctors choose to practice. However, they can sometimes turn sour and have serious consequences on physician health and on the quality of patient care. According to the responses to the latest Health Questionnaire from the Federation of General Practitioners of Quebec, more than one in three doctors surveyed said they felt a high level of stress at work, and 26% suffered from anxiety disorders. While the causes are many, stress and anxiety can result from tensions during consultations. Professionsanté.ca (sister site of canadianhealthcarenetwork.ca) spoke with Dr. Claude Johnson, medical advisor and intervention coordinator at the Quebec Physician Assistance Program (PAMQ), which supported more than 2,400 doctors in 2023.Are all doctors exposed to the risks of conflicts with their patients?Dr. Johnson: Certain areas of healthcare are more at risk, such as psychiatry, geriatrics and emergency, but all doctors can be confronted with problematic situations with their patients, and the sources of frustration are multiple. Patients face problems accessing care, waiting, delays, cancelled appointments or surgeries, or experience confusion about the role of their different care providers.Read: Practice management: When it's time to part waysDoctors and paramedical teams undergo constant pressure from the system and patients, as well as a lack of resources and time, not to mention the daily attacks that end up wearing down their patience. All these factors promote tension, misunderstandings, and ultimately conflicts that can sometimes lead to verbal and physical violence.When we discuss this among medical advisors, we see an increase in difficulties linked to the health system for which doctors are held responsible. When patients do not have good services, they point the finger at the doctor. Doctors are uncomfortable because they are on the frontline and feel a lack of respect for their profession.Read: Patient relations: How best to handle patients who are manipulativeWhat are the consequences of these tensions or conflicts on doctors?Dr. Johnson: The doctors who contact us are under great stress, either because they have been attacked or felt attacked, whether verbally or physically, or because they are the subject of a complaint. The ethical implications, the threat to their integrity or the questioning of their professionalism are very significant sources of stress and worry.As a medical consultant, I try to find out if this stress may be hiding something else, such as an underlying health problem or burnout, which may be making the doctor more irritable or impeding communication.These conflicts can also have a significant impact on the quality of care, since it can be difficult to make an objective decision with a patient when you do not feel safe.Finally, doctors can also exhaust themselves trying to force the relationship, because they feel responsible for the quality of it, even if the patient is objectively not easy. Some develop mental health problems. Despite their goodwill, it is not always easy, or in some cases impossible. Communication is a two-way street.How can doctors protect themselves?Dr. Johnson: The role of PAMQ medical advisors is not to give advice or strategies for managing the doctor-patient relationship. However, we ensure that the doctors who call us have access to the appropriate resources, to manage their health problems or learn to communicate well through workshops on the basics of non-violent communication, for example. It is also important to know how to take care of yourself, to cultivate your well-being—sleep well, eat well, have a balanced personal life, and resolve your health problems. Being more in touch with themselves and their emotions will allow physicians to be aware of their own reactions, and also to be more attentive to their patients and able to detect discomfort, incomprehension or tension. To avoid escalation, it is essential to be able to stop and think to get out of the impasse as quickly as possible. Otherwise, there will be a breakdown of trust, which is essential to the therapeutic relationship.Read: Practice management: When a patient diesBut it is not a question of tolerating relationships that would not be optimal in a doctor/patient context. When a relationship is not working, it is wise to refer the patient to someone else. Unfortunately, the current context of lack of access to care often prevents us from using this solution.Dr. Claude Johnson's remarks have been edited for clarity and conciseness.This article was translated from its original French and was originally published by our sister site Profession Santé.

What can doctors do to handle conflict with patients?

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