May 2002 • Volume 8 • Number 5 |
You're a family physician. You're supposed to treat the whole person. But to do this, it may seem that you have to be all things -- doctor, educator, confidant, social worker -- to all people.
And in a society where minor conflicts too often escalate to violence -- how about referee? Because sometimes you might have to step between two patients and be the mediator, a role you might be reluctant to assume.
But if that's the case, consider this: You've been mediating conflict all along. In any practice, conflicts arise among staff members or between patients and staff.
How you deal with such stressors can serve as a lesson for those around you, says Kevin Sherin, M.D., director of the University of Illinois at Chicago's Christ Hospital Family Practice Residency Program. "We're role models for our patients," he says. "How do you deal with the angry patient? How do you deal with the angry staff person? How do you deal with conflicts between residents-in-training?"
Mediation skills gleaned from these situations can be used to help patients, says Sherin, who has written a monograph on intimate partner violence for the journal Hospital Physician.
The key is not to view conflict as a bad thing, says Deborah Taylor, Ph.D., associate director at the Central Maine Medical Center Family Practice Residency in Lewiston. Taylor, a speaker on resolving conflicts within residencies, says it is important to approach, not avoid, conflict.
"There are benefits to conflict," says Taylor. "It gives you an opportunity to solve problems and make improvements. It can help you identify and make necessary changes. It helps people to clarify what their goals and missions are, and it keeps people on the same page."
When handled appropriately, conflict can actually strengthen relationships, Taylor maintains.
Another FP's experience bears out Taylor's perspective. Christopher Gaynor, M.D., M.A., a staff physician at Community Health Center of Snohomish County in Lynnwood, Wash., says he jumped into the fray of a family controversy when he noticed strife between an 11-year-old patient and the patient's stepfather. Gaynor says he picked up on "vibes" between the two during a visit at which "the stepfather did nearly all the speaking, and the patient stared at the floor." The patient, recently diagnosed with type 1 diabetes, was struggling with depression.
"So when the mom brought him in at a subsequent visit, I asked about the relationship between the patient and his stepfather," says Gaynor. "The mom admitted that the stepfather had low tolerance for the patient's shenanigans, and that he easily lost his temper and yelled at the boy. The patient, when asked about physical mistreatment, revealed an instance of abuse. What ensued was a powerful expression of mother's dismay that this could have occurred in her home without her knowledge. The boy was ultimately able to hear his mother's commitment to preventing further physical violence against her son, but also a commitment to working things out with her spouse."
The revelation enabled healing to take place, says Gaynor. By the next visit, the patient's depression had improved and he had enrolled in counseling. Furthermore, the stepfather had agreed to leave limit-setting to the boy's mother and enrolled in anger management classes.
Positive outcomes such as this require that the physician be perceptive enough to recognize potential sources of conflict.
Sherin says conflict management needs to be better addressed by the medical school curriculum. "The whole issue of conflict resolution is certainly on the prevention side of the kinds of curricula that need to be out in the communities," he says.
To be effective, residents need awareness of intimate partner violence, child abuse and elder abuse, he says. But the larger issue for society to grapple with is how to prevent violence in the first place.
FP Report is published by the
AAFP News Department.
Copyright © 2002 by
American Academy of Family Physicians.