Dealing with Conflicts Effectively

Coach’s Corner
CSPE Newsletter

None of us like conflict, yet managing conflict effectively is an essential skill for the physician executive.  Conflicts are inevitable, and cannot be avoided.  All a conflict means is that two people do not agree about something – this will happen between any two people in any relationship at some point.  Conflicts do not have to be horrible and ugly.  They are often uncomfortable, but this is only temporary and then resolves.  Conflicts do not have to have a winner and loser, nor be a “fight to the death”.  Much of the time, both sides can work together to arrive at a compromise. 

Most conflicts happen because people get stuck on the solution.  Each one wants to have their own way.  The solution is actually the last step in this process.  Conflict resolution must focus on needs, not solutions.

There are four steps to conflict resolution. 

  1. Identify your need(s).  Many physicians have to do this separately and consciously, finding this initial step so difficult, because we are so used to unknowingly giving up our needs, often without even knowing exactly what they may be.  Take some time to think about what factors the solution will have to take into account.
  2. State your needs.  Once you have identified what they are, you need to say them to the other person.  They cannot read your mind.  Practice with short, clear, direct statements, using “I or me”. 
  3. Listen to the other person state their needs.  If they do not volunteer this, ask them what they would need in this situation, and listen. 
  4. Work together towards a compromise as a solution.

Most people start to feel resentful when their needs are unmet.  Resentments are the beginning of the end of a relationship, in your personal or professional life.  Catch them early.  Find your cue that tells you that you are feeling resentment – it can be a feeling you know but cannot describe, it can be a physical sign like clenching your teeth, clenching your fist, churning inside.  Then, having recognized your early cue, remember that “Resentment = Unmet needs”, and try to define and state these needs.

There is no “perfect” solution, just a “workable” one.  Once you have agreed on a solution that appears to work, go with it for as long as it works.  This could be for a few minutes, or a few years, or forever.  Once it stops working, usually because you have become aware of new needs on either or both sides, you are merely back to the four steps again to find a new, workable, solution.

What if the other person does not cooperate or listen, and responds angrily?  There are two parts to this situation: dealing with your own anger, and then dealing with the other person’s anger.

Our own anger can be uncomfortable to us.  We feel guilty, as if we have no right to be angry.  We are more comfortable with being caring, patient, tender, and compassionate.  Anger, as a feeling, is always appropriate; it is how you express it that makes it more or less acceptable.  

The best way to start to address your own feelings is to acknowledge and identify what it is.  Some of us are so uncomfortable with “negative” feelings, such as anger, that we deny them and so do not even know when we are angry.  Understand your own anger.  Anger is always a secondary response; it can follow feeling hurt, afraid, sad, disappointed, or embarrassed.

The Four Letter technique is a great tool to use when angry.  Write out your angry feelings in a letter, addressed to the person directly.  Say exactly what you want; do not hold back or edit your thoughts and feelings.  However, this is not a letter that you will ever send.  This is a crucial point, and bears repeating – do not send this first letter.  It is never productive for anyone else to read.  While it may sound like it captures your points perfectly at the time, it is too intense for anyone else to understand.  Rip it up.  Press delete.  When you start to feel the same again, write out a second letter, then a third and then a fourth. By the time you get to the fourth draft, you are likely calmer, your writing makes more sense, you have probably found a more balanced perspective, and you can decide IF you need to address it further.

Venting your feelings to a highly trusted family member, friend, or colleague may help too.  If after this, you feel you want to address the issue productively to the person, decide what point you want to make, and use “I and Me” statements to express how you are feeling. 
It helps to be clear, direct, and succinct.  Watch out for preambles and modifiers, words and phrases that make it easier and softer, such as “If that’s alright…I hope you don’t mind if…sort of…I may be wrong about this but…” since they dilute or discount the point you want to make.  Plan out your thoughts, and keep it short and simple and quick.  This will be your “Bottom Line”. 

Use the Mirroring and Broken Record techniques to state your point assertively.  Listen to the other person, and then respond with a two-part statement.  The First part is the “Yes, I hear you”, in which you mirror by restating what they have just said or what feelings they have just expressed, so they know you have heard them.  You reflect back their point of view without necessarily adopting them.  Yet, don’t stop here.  Continue on to the Second part of the statement, in which you stand your ground and state your bottom line.  Thus, whatever the other person says, you can agree with something of what they have said; and then state your bottom line.  You can repeat this over and over, as they bring up new points, like a broken record.  This has many benefits – your point is consistent and easy for you to remember, it is reinforced as you say it repeatedly, and you do not go off on a tangent since you keep coming back to the same bottom line.

Once you ask for what you want, it is helpful if you can reframe it, to show the other person how it can benefit them too.  Often, the needs of both parties are not mutually exclusive.  Highlighting how it helps both of you can help you work together towards the same goal, instead of remaining at odds. 

Just asking for something, no matter how clear and direct, is not always enough.  There are two more factors that help meet the goal.  Set a deadline, by which your stated expectation must be met.  “When do you think you can get this done by…I would like to have this completed by…” Then, define a consequence if this deadline is not met.  A consequence can be serious, but often it is not dire, just a way to ensure that you can follow up.  “If I do not hear back from you by tomorrow afternoon, I will call you”.  All three components – setting clear expectations, deadlines, and consequences – are most likely to lead to successful follow through.

Sometimes, you just need to decline or disagree.  It is Ok to say no.  Follow the three easy steps:

  1. Open your mouth.
  2. Say “No”.
  3. Close your mouth.  We often continue on to explain, apologize, make excuses, in an attempt to please and retain approval, yet this is not always necessary.  “No.” is a complete sentence.

The key is to be strong and state your point calmly and definitely, without being destructive.  Speak confidently, and if you don’t really feel confident at first, “fake it until you make it”.
It gets easier with practice, especially when you see the results it brings!

How do you deal with anger from someone else?  First of all, anticipate it, so you are not caught off guard.  The single best way to defuse anger is to agree.  You do not have to agree with all that they are saying, but you can always find some aspect of it to agree with.  Sometimes, all we can agree with is that they are angry; this is enough.  This can help to calm things down.  Their anger is also secondary, so one can try to understand the underlying cause.  Recognize that anger is also a part of the grief reaction, so explore potential existing losses.

If the other person continues to express anger, yell, or call names, you can call them on their behavior.  “I beg your pardon…That sounds like an insult.  Did you mean it that way?”

Remember, you do not deserve to be yelled at.  Ask them to stop.  Say “please stop yelling.  I will discuss this later in private.” Or “Stop.  I do not like to be yelled at.”

Continue on to set limits.  Here are some steps:

  1. Acknowledge the situation. “It’s clear that you are upset”
  2. Commit to your involvement.  “I am happy to work with you to address it”.
  3. Describe what behavior you do not like.  “Words like…When I hear you say…”
  4. Describe the effect of this.  “I get defensive…I shut down…I don’t want to work with you”
  5. Give your preferred scenario.  “I would prefer it if you could calm down and tell me what you would like…”
  6. Mutually positive consequence.  “that way, we can work together to sort this out…”

Overall, we have control in this situation, if we choose to use it.  You have no control of others’ behavior, but you can control how you react to it.  You can also control how much you allow it to impact on you.  If you woke up that day planning to have a good day, do not hand over control of how your day goes to, of all people in your life, this person.  Have the day you want to have.

Mamta Gautam is an Ottawa psychiatrist who specializes in treating physician patients. If you have a question you would like addressed in this column, please contact Dr. Gautam at Please include “Helping Hand” in the subject line. All inquiries will be confidential. Your questions will not be replied to, but may be selected to be answered in this column, which is intended to be educational, not therapeutic.