Conflict is normally created by a trigger; such a trigger might simply be that a patient feels their wait is too long, that they’re not getting the treatment they need or that they feel someone’s being rude to them. While the trigger might occur in the practice there are usually a series of incidents prior to the patient’s arrival that have led to this point.
A practice can’t deal with what happens before the individual gets to the surgery but, from the moment they arrive, staff can take a proactive response in order not to antagonize and to avoid conflict.
Finger on the trigger
We all have our own triggers but, in the practice environment, some factors can intensify them – for example, patients might be in pain, suffering from lack of sleep or there might be fear or anxiety. To pin point what the trigger is – or might be – it’s necessary to observe a patient from when they arrive or even to ask them, ‘What is it that’s upsetting you?’
When a patient first enters a surgery they will instantaneously make their minds up about the first people they see – most likely the reception staff. This is often based on body language. The patient’s initial judgement is made in two different ways: subconsciously/unconsciously – which is done in an instant – and then within six or seven seconds of meeting them – in which time they’ll decide whether they like that person and have some rapport with them, or not. Should they decide that they don’t like that person, if something goes wrong, they will probably blame that person.
In any negotiation that initial contact is so important. When a patient walks into a surgery staff should focus on using positive body language – for example, eye contact – and acknowledge the patient. It’s important to exercise empathy; they’re in the surgery for a reason – because they’re in some kind of distress or they have a problem – and have come to you to solve that problem.
My doctor comes out to meet me, greeting me palm-up. The significance of this gesture is that it signals peace and, from a body language perspective, that’s a very positive and proactive thing to do. He‘ll also address me, ‘Hi Darren, come this way. Let’s see what we can do for you today.’ If we break this down; ‘Hi Darren’ shows that he knows me, we have rapport, it’s personal; ‘come this way’ – guiding me in an empowering manner; ‘let’s see’ is like a negotiation; ‘what we’, the ‘we’ suggests inclusion and collaboration, we’re a team; ‘can do’ is an action phrase and suggests we will find a solution; ‘for you today’ adds a time frame to proceedings.
And then he’ll walk with me – at my speed – and as he does this he is assessing me, doing his diagnosis as we’re walking to his consultation room. Then he’ll sit down, perhaps lean forward to demonstrate interest, ask again what we can do – and through his body language show that he is listening to me.
The rules of communication
Dr Stephen Covey lists five ways of listening: not listening; pretend listening; selective listening; active listening and emphatic listening. It’s thought that the best way of de-escalating conflict – which could go on to become a complaint against the surgery – is by using emphatic listening. Empathic listening is active listening, with the intention of seeking to understand before being understood – putting yourself in the shoes of your patient.
When communicating with patients it’s important to remember the importance of linguistic patterns, and also the power of your tone. A study by Albert Mehrabian revealed that body language makes up 55% of our communication, tone makes up 38% and the words are only seven per cent. Tone is important – especially on the telephone. Palm-up body language demonstrates that there’s no danger, makes a patient more comfortable and helps them to communicate.
When speaking with a patient you might use what’s known as the ‘Columbo technique’ – check that you have rapport with them, perhaps starting with some softening. At this point a patient will give the go ahead, or say no – in which case you need to go back to building rapport. If they say yes, then you move on with your line of questioning – again ensuring you’re listening with empathy, nodding at the same speed the patient is talking, to demonstrate you’re on the same wavelength and checking with them that you’ve understood their situation. What you want is the patient saying ‘Yes!’ because ‘yes’ is the most important word in the English language. It’s also important to manage their expectations – telling them how long they can expect to wait and that you will fulfil your intentions.
Using these simple techniques will ensure your patients have a good experience each time they attend your practice and, where you have a difficult patient or a situation that might get sticky, your body language, your tone and the words you use can be key to avoiding a conflict – as they say, ‘prevention is better than a cure’.