Consultation Skills

Conflict in the Consultation

Conflict at some point is inevitable

At some point in your consulting, you will encounter a conflict situation with a patient.  For instance, a patient might not agree with you about something or might be angry about something that you or a previous doctor did.   Getting confrontational back or just reacting straight away in a defensive way is not likely to improve the doctor-patient relationship and may indeed escalate the negative situation and in some cases ending up with the doctor being thumped!  Clearly, you don’t want that.

But there are models for dealing with conflict.  For example, there is an simple model called AFVER for handling the patient who is angry with something you or someone else has done.  It goes something like this…

  • A is for Avoiding Confrontation – because it just makes the situation worse.  Instead say you are sorry to hear that they are upset and that you want to find out more so you can help them better.
  • F is for Facilitate discussion – allow them to speak.  Try to show a genuine interest in trying to understand what went on.   
  • V is for Ventilating Feelings – allow the patient to vent their feelings.  Once they are out, they will respond more positively.
  • E is to Explore.    Explore what went on and clarify anything you don’t understand.
  • R is for Refer/Investigate – Tell the patient you will investigate the matter or put them in touch with someone more appropriate to look into the matter eg the Practice Manager.

And in terms of outcome, you might want to (ABCDE)

  • Agree with the patient (agreement often settles disputes!).  But only agree if you really do mean it. 
  • Bargain with them – that you will make an exception on this because of…..
  • Counsel – clearly just allowing the patient to “lament” and express themselves is enough to help an emotion-releasing (=cathartic) intervention.
  • Make a Deal (or Negotiate) with the patient – “I understand how awful that must have been.  Now, I know you want xxx – can I suggest something that might keep us both happy?”
  • Educate – patients have certain perceptions which explain why they feel the way they do.  But once they see their perceptions are misperceptions, they are more likely to back down and apologise.
There are, of course, other models.  Have a look at them in the downloads section.   Find something that suits your style.


Please leave a comment if you have a tip, spot an error, spot something missing or have a suggestion for a web resource.
And of course, if you have developed a resource of your own, please email it to me to share with others.

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