Office Culture: Fight the Good Fight<

by: Barbara A. Gabriel, MA

Physicians are notorious conflict avoiders, but ignoring it won't make it go away.

When Richard Hansen recently asked a roomful of physicians he was mentoring on good management practices how many of them approached conflict in their businesses by simply avoiding it, a majority of hands reached for the ceiling. "'I can't stand conflict,' is a statement I hear from physicians over and over," says Hansen, a consultant with the Medical Group Management Association. "I've seen physicians ignore major problems in their practices for years on end simply because they can't bring themselves to deal with them."

Hansen was once brought in as a mediator to intervene in a practice in which two feuding physicians refused to work with one another. "If one of them entered the office from the front, the other one entered from the back," says Hansen. "If one saw the other's car in the back parking lot and knew he couldn't avoid seeing him, he'd call the front desk on his cell phone to cancel his appointments for the day." This example is extreme, but the disruption caused by unresolved office conflict is often severe.

Are physicians more averse than other professionals to dealing with the conflicts that inevitably arise in all business settings? Many experts say yes.

"Physicians have reached their professional standing because they have excelled as individuals," explains Leonard J. Marcus, PhD, director of the Project for Health Care Negotiation and Conflict Resolution at the Harvard School of Public Health. "They have achieved success in medical school, in their residencies, and in their specialties. However, working within a medical practice requires collegiality and collaboration, as individual physicians are part of a larger healthcare delivery system. Successful medical practices require teamwork — not solely individual achievement — but that is not how doctors are typically trained."

Barry Dorn, a practicing orthopedist and associate director of Harvard's Project for Health Care Negotiation and Conflict Resolution, agrees that "many doctors don't have great communications skills."

"We were never taught that in school," says Dorn, "which is kind of ironic, since good communication skills are an essential element of our everyday routines."

Hansen says that patients reinforce this problem when they expect physicians to "have an opinion and stick to it." In general, says Hansen, patients look to their doctors to take charge and solve the problems they present, not to huddle with other docs to come up with the best treatment approach. As a result, Hansen says physicians are generally unaccustomed to being challenged by others, and they don't know how to respond when their authority is questioned.

WHO SUFFERS?

Dorn maintains that when physicians use the "blind eye" approach to conflict within their practices, "It inevitably comes back to haunt them."

"Conflict always builds in a practice," says Dorn. "It's how you deal with it that matters. I once had two younger physicians in my practice who were always at each other's throats. When I asked one of them about it, he said to me, 'Well he did this and this and this to me two months ago.' I asked him if he ever said anything about it to the other physician, and he said no. It was never expressed. The definition of conflict is 'an expressed difference between two people.' If you are upset at someone and you do not express it, all you have is anger. It is when you respond that you set the tone for the conflict. How you express your displeasure is everything."

Dorn says conflict among physicians inevitably affects patient care. "Patients really suffer when doctors have conflicts with one another," he says. When serious co<

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