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ER Goddess

ER Goddess

Hollywood Medicine is Always Perfect, but Real Medicine Can Be Messy

Simons, Sandra Scott MD

Emergency Medicine News: May 2019 - Volume 41 - Issue 5 - p 14
doi: 10.1097/01.EEM.0000558183.15876.c0
    real life emergency medicine
    real life emergency medicine:
    real life emergency medicine

    I stride into work looking like Reese Witherspoon. All my patients have actual emergencies, and I never touch a keyboard or click a mouse. When conflict arises, I navigate deftly through the drama with interpersonal grace, winning the adulation of patients and staff. Cue credits.

    That's Hollywood medicine. In real medicine, the acting might not be as good, but we non-movie-star physicians learn to role play. We suppress our inner dialogue and honest comments, and we strive to find the movie-perfect words to resolve conflict. But real medicine is messy, and we don't always win the adulation of patients and staff. We make people mad despite our best intentions. Then what?

    The true art of medicine is convincing people to do what we need them to do. Dealing with medical emergencies is often the easy part compared with dealing with difficult personalities. Healthy conflict resolution is as vital to good medicine as pressors and ET tubes, but nobody gives us a script. We tend to glean strategies for conflict management by failing gloriously and later realizing what we should have done. Instead of learning the hard way, we should familiarize ourselves with tactics for healthy conflict resolution as residents and review them throughout our career. The following tips can make our medical practice a little less messy and a little more Hollywood. These are useful for the ED and for life.

    1. Maintain your composure during a disagreement and respond with relentless respect. If someone raises his voice, lower yours. You are practicing one of the noblest professions; act like it.

    2. Manage your defensiveness. Medicine is a profession of egos, and physicians like to be right, but our ability to solve problems is greatly diminished when we're only defending how right we are. Keep your ego in check, or you'll never see the other person's perspective.

    3. Really listen instead of merely waiting for your turn to talk. Physicians are trained to interrogate and to listen for the details we want. Silence your brain from thinking of your next statement and concentrate on the other person. Use the active listening technique of paraphrasing her perspective to let her know you've heard and understand her concerns.

    4. Show empathy by legitimizing the other person's opinion. You are neither giving in nor telling him he is right by saying, “If I were in your shoes, I might think the same as you.” Try it. Putting on a white coat does not make you the only one with a valid opinion.

    5. Keep in mind that people may personalize a conflict and see it as an interpersonal issue even when the disagreement is not personal. Avoid hurt feelings by making clear that it's not a relationship issue when what's intended is a content discussion: “This is about the patient care.”

    6. Stick to the facts. Judgmental statements such as “You're slow” are not constructive. It's more effective to describe, not evaluate, behavior: “Mr. Smith still hasn't received his pain medication.”

    7. Focus on the goal, not the mistake. Rather than saying, “I ordered his morphine an hour ago, and you haven't given it,” say, “Mr. Smith really needs to have his pain controlled.” A physician who gives positive alternatives is better for ED morale than one who constantly says no or criticizes.

    8. Focus on the problem, not the person. Statements starting with “you” sound accusatory; the other person will build a mental barrier to protect herself from the incoming attack.

    9. Avoid the words “always” and “never.” These generalizations are usually inaccurate and heighten tensions.

    10. Refrain from piling on criticism. Nothing raises a person's defenses faster than hearing, “And another thing....” Not resolving one topic before moving on to the next risks jumbling the argument so that none of the issues gets settled effectively.

    11. Mind your body language. Much of the emotional impact of a message comes from body language and intonation. Even if you say “I'm fine,” unconscious nonverbal cues will betray you. Unclench your jaw; uncross your arms. Many people find the white coat intimidating enough (i.e., white coat hypertension); threatening body language doesn't help.

    12. No cursing. Offensive language is not only unprofessional, it's inflammatory. Steer clear unless you want to provoke conflict instead of resolvng it.

    13. Focus on the future. When old grievances inevitably come up, don't rehash the past. Shift the focus to what you (or your attacker) will do differently moving forward.

    14. Use humor as a way of creating rapport. As long as it's not sarcastic or biting and is directed at yourself or the situation and not the person with whom you're in conflict, humor can de-escalate the situation.

    15. Never discuss conflict in writing. Everyone seems to be email-happy, Quantros-happy, and screenshot-happy. It might be easier to send an email than to muster the courage to talk to someone directly, but it is not the best way to resolve conflict. Written communication lacks the nuance of verbal or visual communication.

    All of these tips are easier said than done. I struggle to be my best self when things get heated. Sometimes it's all I can do to see all of the patients and write all of the charts. Then I have nothing left in the tank for gracefully finessing a conflict. Incorporating even just one tool could prevent an interpersonal blow-up and make a difference in how the whole scene plays out.

    If all else fails, be honest with yourself and change any of your behaviors and attitudes that might be contributing to conflict. Without a script or an opportunity for a Hollywood retake, we're going to screw up, and that's OK. Mistakes in real life make us wise, and we don't want to edit them out.

    Dr. Simonsis a full-time night emergency physician in Richmond, VA, and a mother of two. Follow her on Twitter@ERGoddessMD, and read her past columns at

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