The online text for Ecology of Health and Medicine (EHM)
IPE: Teamwork and Values Conflicts, Working with Challenging Patients
Teamwork and Values Conflicts
We share core professional values but sometimes our values conflict with those of another (perfectly reasonable) team member. The training and practice of an occupational therapist emphasizes safety, which was in direct conflict with patient autonomy in this specific patient case.
Conflicting opinions are a normal part of working in teams. Successful teams a) assume positive intent, b) listen to each other, c) make sure every person on the team expresses their view, and d) concludes conflicts by negotiating a plan for next step/s.
Place the patient at the center of the team. Understanding the patient’s perspective on health and healthcare places the patient at the center of the team’s conversation, and can help all team members get behind a plan that meets the patient’s needs.
Listening and speaking up are critical team skills. Listen as much (or more) than you speak. But speaking up is important for all team members to share their concerns or new information.
We can’t always be the hero. Sometimes we can’t “save” a patient. When we have different goals or health beliefs than a patient, we may not always feel good about our what we are able to do (allowed to do) for a patient or the patient’s outcome.
Don’t take it personally. When you feel challenged by a patient, ask other team members how it’s going for them. Don’t assume you’re the problem, or are the only one having difficulty. If you’re frustrated, it’s likely others on the team are too.
Talk to your team first. When you feel challenged by a patient, don’t go it alone. Use your team to help you problem solve. Difficult patients can split us as teams. Knowing other’s roles and responsibilities and using them to full potential can share the burden of high maintenance patients.
Think broadly when you think “team”. Physicians, nurses, pharmacists and social workers practice in close proximity, often rounding together, but other team members may not be in the loop. Remember to include everyone in challenging care decisions.
Support your team members. Especially when we have a challenging patient, we need to rely on and trust our team members to do their jobs. Work together to adopt a common approach.
Working with Challenging Patients
“Difficult” patients: Challenging behavior is often a sign that, from the patient’s perspective, her/his needs aren’t being met.
Engaging patients: Exploring patient’s preferences in a non-judgmental way is key to enhancing motivation and engagement, both of which are essential to effective care.
Respect for patient autonomy: Ultimately, patients make their own decisions. The challenge for providers is to take the journey with them, work creatively to bridge medical aims and patient priorities, and provide support.