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Every Practice has Conflict, But Only Some Handle it Well

John Commins, for HealthLeaders Media, February 18, 2010

Spend enough time in a doctor's office—either as an employee or a patient—and you're going to encounter conflict and tension.

For patients, already anxious about their health, even during well visits, it can be particularly unsettling to hear voices raised or accusations flying. It may be a receptionist dealing with a patient who has just been informed that his copay was raised. It could be an office manager confronting a billing clerk over a documentation error. It could be a physician assistant's personal troubles spilling into the work place.

Whatever the reason, conflict is a cancer in the healing environment. It has to be contained.

For years, Terri Levine, president of North Wales, PA—based Comprehensive Coaching U, has parachuted into stressed out physicians' offices to negotiate an end to hostilities.

"I've never seen a business, a corporation, a physician office, that doesn't have conflict," Levine says. "People are people. There is conflict in our experience. It's part of humanity." By far, she says, the most prevalent form of conflict is among coworkers.

Because of the serious nature of the work in physician offices, even on the best of workdays, stress—the seed corn for conflict—will always be present.

"There is more stress that we find particularly in medical doctor practices than in any others," Levine says. "In a retail store, you mess up, you don't ring up the right order. In a physician's office, you can be dealing with serious life-and-death issues. And the other thing is that most physicians are Type A personalities. Just by the nature of who they are, they can create stress even if they don't open their mouths."

Conflict isn't always about screaming matches at the front desk.

"Sometimes one employee could be angry with another and could be withholding information, being quiet, not giving them everything they need, forgetting to give important data and messages," Levine says. "Anger. Talking behind the other employee's back. Sarcasm. Those are the warning signs that something needs to be handled. Usually it is underneath the surface and you have to look for it because it can become a shouting match."

Paula M. Comm, a practice administrator at PRA Behavioral LLC, serving the northwestern suburbs of Chicago, says the head psychiatrist at the practice has a zero tolerance policy toward workplace conflict. "He hates conflict, and he really practices what he preaches," Comm says. "Especially in a psychiatric practice, you don't want someone coming to the window and feeling the tensions that are going on within the office because it's so apparent."

Comm says she is aggressive in sniffing out workplace tension. And one of the best ways to do it, she says, is to get out of your office and stand in the hall and listen.

"I go up there and just stand. I can get a feel for what is going on immediately. I can tell by the tone, by the attitude. I have an office manager beneath me who isn't attuned," Comm says. "So, I will go in and stand up there and go to her office and say, 'Do you know that it's tense up there?' And she will say 'what do you mean?' "

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