Conflicts in ED

Conflicts often arise in the ED between colleagues, support staffs, patients or their relatives, and administration. Such scenarios are seen everyday in the ED and are often tested in most OSCE Stations in the MCEM Examinations.

The patient may be curious to get certain tests or intervention done or may just deny any recommended intervention. The ICU or floor doctor may refuse to accept a patient or may blame your junior doctor for repeatedly disturbing him for trivial reasons. The best way to manage a conflict is:

• ANTICIPATE A CONFLICT TO ARISE
• BE PREPARED FOR A RESPONSE
• EXPLORE HIDDEN AGENDA
• BE ASSERTIVE AND AT THE SAME TIME ENCOURAGE COOPERATION
• SEEK COLLABORATION OF CONFLICTING PARTIES

Some listed examples are as follows:

1. A patient with a mechanical low back pain insisting on a X ray Spine

• Listen to his problem
• Question why he feels an X ray would be required
• What are his ideas
• Explain him the rationale of not doing the X ray and harmful effect of unnecessary radiation exposure
• Offer to re-evaluate the patient and discuss
• Offer pain medicines and schedule him to be re-evaluated again in a few days

"At this moment, I do not feel doing an X ray would be beneficial for you. The X rays are done to look for any bony defect like fractures and dislocations. In mechanical low back pain, the X rays would just show normal bony appearance. I would recommend you taking the pain killers that I would provide, and let me examine you again in a few days. If there is need for any further intervention we would do it then. Does that sound Okay with you?"

2. Doctor, my father had Cancer, do you think I too have it?

"It is too early for me to answer this question. I need to ask you few more questions, and then we would go through a complete physical examination. I would also need to run some blood and other tests on you. Then we can sit and discuss your concerns. Is that okay with you?"

3. Doctor, but I was told 2 days ago that there was no fracture on my X ray, and, now the hospital calls me back and says that there was a fracture which was missed. I am so upset. I need to file a complaint.

"I totally understand that you are upset and angry. I feel sorry that the fracture was missed. But I want to tell you that it was a very small fracture which could have had easily missed by anyone. Hence, we have a protocol of reassessment of all images by a radiologist for his opinion. And when we found that out there was a small fracture, we felt it was essential to inform you. I am going to reassess you and see what we have to do about it."
"I would bring up this issue at our weekly educational meeting, and we will see to it that all our ED doctors reinforce themselves through an X ray teaching sessions."
"If you want to write a complaint, I will help you with providing the details. You can address your concerns to Patient Advisory and Liaison Services, and they will reply to you in 20 working days."

(To be continued.....)