- Email: [email protected]
From Conflict to Collaboration
INVISIBLE TO THE EYE
RICHARD B. GUNDERMAN, MD, PhD
From Conflict to Collaboration Richard B. Gunderman, MD, PhD, Arthy Saravanan Anger is like acid that does more harm to the vessel in which it is stored than to anything on which it is poured. —Mark Twain [1]
Radiologists sometimes encounter tense interpersonal situations of one type or another, yet few have any formal training in how to manage conflict. Consider the following scenarios. A referring physician storms into the radiology reading room. “What is wrong with you people? Do you have any idea how long my patient has been kept waiting? Over an hour! And for what? A simple chest radiograph! What kind of way is this to run a radiology department? Believe me, the hospital CEO is going to hear about this first thing tomorrow morning!” A department chair receives a phone call from an angry staff member. “I just heard that we are not getting raises again this year. I can’t believe it! We work as hard as any other group of radiologists, but what reward do we get? It just isn’t fair, and this is the last straw. I am going to start looking for another position, and I intend to encourage others to do the same.” A radiologist is called to see an upset patient. “I am so mad at your department. I drove over 2 hours to get here, and I had to take the day off work. When they finally brought me into the room for the exam, the technologist asked a few questions, called the radiologist, and they decided that I was scheduled for the wrong exam. Now I must come back tomorrow. Don’t you people have any respect for your patients’ time?” Such situations may involve not only referring physicians, colleagues, and patients but also technolo-
gists, nurses, and hospital managers, among a host of others. Radiologists may be the best lesion detectors and differential diagnosticians in the world, but if they do not handle such tense situations effectively, everyone is liable to suffer. To do better, radiologists need to recognize that just like other professional responsibilities, responding effectively to such situations requires knowledge, skill, and judgment. In this column, we outline different paths radiologists can follow in responding to potentially tense situations. Although these approaches do not exhaust all possibilities, they provide a convenient model for thinking about the basic issues at stake and help illuminate alternative visions, strategies, and tactics for handling interpersonal problems more effectively. These approaches are not mutually exclusive, and radiologists may move from one to another. Moreover, some conflicts involve more than two parties, and the approaches outlined here would need to be adapted accordingly. CONFLICT We define a conflict as a disagreement that one or both parties construes as a win-lose situation. For party A to win, party B must lose, and for party B to win, party A must lose. The problem with this approach is that it treats disagreements as zero-sum or negative-sum situations, in which the only way for one party to gain is for the other to give up something. People who see conflicts in these terms are unlikely to look for solutions that might benefit both parties. When both parties treat a disagreement as a conflict, they imme-
© 2010 Published by Elsevier Inc. on behalf of American College of Radiology 0091-2182/10/$36.00 ● DOI 10.1016/j.jacr.2010.08.003
diately begin to disregard the other party’s interests, simply assuming that the other’s claims are unimportant and not worth worrying about. When we operate from such a mind-set, we are likely to think, talk, and act in ways that imply loss by the other party as a foregone conclusion [2,3]. Each party finds itself in a mentality of “eat or get eaten,” which tends to short-circuit possibilities of cooperation and building a better long-term relationship. To avoid falling into a conflict-ridden mentality, radiologists need to guard against the temptation to paint other parties— whether referring physicians, colleagues, or patients—as opponents or enemies [4]. Generally speaking, no one deserves to be seen as the bad guy. CIRCUMVENTION A synonym for circumvention is avoidance. A common approach to frustration and anger among physicians, circumvention may in some cases prove helpful in lowering the levels of tension [5,6]. But circumvention is generally not the best strategy, in part because it often only postpones the inevitable and may in some cases merely cause levels of tension to escalate. The crucial question is not, “What course of action would produce the least discomfort for me?” Instead the question should be, “What decision would be best for our organization, our patients, and our community, and what do we need to do to promote their interests?” A key means of preventing conflicts is to invest in relationships. If a problem arises between two colleagues who already enjoy a strong 831
832 Invisible to the Eye
working relationship, they are much less likely to adopt an aggressive win-lose mentality in attempting to resolve it [7]. But key to building relationships is honest and open communication, and the parties involved need to be sufficiently secure in their relationship to trust that they can share concerns and even complaints with one another. COMPETITION We use the term competition to refer to situations in which one or both parties seek to use a particular disagreement to shift the balance of power in their favor. Such a perspective may prevent one party from even grudgingly admitting that there is merit in the other’s perspective. An adverse outcome of a competitive approach to disagreement is capitulation. In this case, one party simply surrenders and accedes completely to the other’s demands. Yet the outcome may be unfair to both parties. Merely resolving a dispute should be a lower priority than reaching a just outcome that all parties can live with. Moreover, capitulation may engender deep and long-lasting resentment, leaving one party feeling unfairly taken advantage of. Finally, capitulation deprives both parties of the opportunity to improve their negotiation skills. The opposite of capitulation is conquest. The aim of conquest is to gain control over the other party. One way of doing so is through a massive show of force. Another is by trapping the other party. A shrewd conqueror may accept the loss of a battle to win a war, by getting the other party to betray its core principles. Once such a betrayal occurs, trust between leaders and their colleagues is lost, and it can be difficult or impossible to restore [8].
CONVERSATION To turn the corner from conflict to cooperation, it is necessary to move from win-lose to win-win. But before we can know the other party’s interests, we need to spend some time getting to know them. And this means listening to them. Listening is an art. It means not just being quiet but responding to what others are saying, asking questions, making the effort to restate what we think we are hearing, and acknowledging when they have a valid point. Every complaint is an opportunity to gain a deeper insight into how someone else sees our daily work [9]. By moving from a perspective of competition to one of conversation, we naturally tend to lower the temperature in the room by letting the other party know that they matter to us as persons. Knowledge is empowering, and by making the effort to understand another person’s point of view, we help transform antagonism into cooperation and lay the groundwork for partnership [10]. In this respect, radiologists who find themselves confronted with aggression can often assume the role of educators, not by lecturing but by serving as a role model of how to handle conflicts in a more fruitful fashion. COLLABORATION Conversation is a necessary condition for collaboration. When we adopt a collaborative perspective, we continue seeking to understand the other party’s point of view, but we move from theory to practice, asking questions that are intended to help solve problems [11]. One collaborative approach that can prove highly disarming is to ask the other party’s advice: “If you were in my shoes, what would you do?” It is not always possible to begin collab-
orating in the midst of a heated discussion, but the radiologist’s every word and gesture can be shaped by a longer term effort to transform combatants into collaborators. The goal is not just to reach a resolution of the problem at hand but to work together in doing so. In this sense, the problem can become more of a blessing than a curse because it serves as an opportunity for the parties to begin to talk, imagine, and act together. To operate from a competitive perspective is to sell ourselves short. It means always putting ourselves first. It increases our tendency to think and act selfishly and without regard for the legitimate needs and interests of others. On the other hand, pursuing the possibility of collaboration tends to foster the development of important virtues, such as the capacity to see things from others’ points of view, to approach situations from the standpoint of fairness and mutual benefit, and to subordinate our narrow, short-term impulses to the pursuit of greater long-term objectives. COMMITMENT Commitment asks the problem solver to approach the dispute as an opportunity to build better relationships and organizations. The goal is not just to work together to resolve the point of contention but to do so in such a way that both parties achieve a higher level of mutual commitment. If we expect from the other party nothing but a “kill or be killed” mentality, then we will rarely be unpleasantly surprised. But if we have been working hard to take the high road and the other party suddenly shifts to the low one, the door is opened for grave disappointment and even betrayal. Enhancing commitment requires us to adopt longer term, more com-
Invisible to the Eye 833
prehensive, and deeper objectives with which to approach disputes [12]. We do not want to crush or embarrass the other party, leaving them feeling worse about themselves and their work. We do not want to bring out their worst. Instead, we want to help them to rediscover and act in accordance with their better selves, adopting courses of action that they can be comfortable with and even take pride in. Instead of spawning an enemy who will always rejoice in our downfall, we aim to create a trusted colleague, even a friend whom we can count on in times of trouble. CASES How might radiologists use these categories in navigating tense situations? Here are examples of how a savvy radiologist might respond to the frustrated individuals described in this article’s opening. Irate Referring Physician “Thanks for taking the time to come and meet me in the reading room, Bill. I know you are busy, and I am grateful that you took the time to visit in person. You are clearly upset about the amount of time that has elapsed since you sent the patient to our department, and I don’t blame you. An hour does seem like a long time. Let me look into this to make sure that we understand the situation accurately, and then let’s commit to working together so that we can prevent a similar problem in the future.” In this case, the delay in service may be radiology’s fault. On the other hand, the fault may lie elsewhere. Perhaps transporters were slow to bring the patient to the department. Or perhaps the patient chose to stop for a snack on the way. The problem may even lie with the requesting clinic itself. Perhaps the order for the examina-
tion was never entered, and technologists have spent the past 45 minutes trying to get the clinic to place it. Failing to do some fact finding can result in misallocation of blame and failure to learn important lessons. Irate Colleague “Thanks for calling me about this, Mary. I can understand your frustration. I, too, would like to be getting a raise this year. Your concern makes me think that we should be doing a better job of sharing information about our practice’s financial status and the various pressures we are experiencing that have made providing raises problematic. I could use some help in devising a way to do this more effectively. Before you seek other employment, why don’t you and I meet again soon to discuss this? I bet you would come up with some ideas that would benefit us all.” Group members have a strong interest in the financial status of the organization, and it is important that such information be shared, so that everyone operates with a clear picture of where things stand. By treating such a complaint as an opportunity to enhance communication and draw on the problem-solving capabilities of a talented colleague, a leader can turn potentially ugly situations into formative and beneficial experiences. In doing so, the focus needs to be on understanding all of the group’s resources and all the rewards it offers its members. Allowing the conversation to focus exclusively on money can implicitly devalue other worthy objectives and demoralize everyone. Irate Patient “I can definitely see where you are coming from, Mr Smith. You feel like you wasted the better part of a day because the wrong examination
was ordered. I am sorry about this. I don’t know at the moment how this happened, but let me look into it and report back to you on your return visit. We are committed to respecting our patients’ time and ensuring that visits to our department go as smoothly as possible, and I want to make sure that we learn from this experience so that it will not happen again to you or anyone else. To make your return visit as convenient as possible, let me arrange for our department to cover your parking and meal costs.” In an organization as complex as a busy radiology department, patients will inevitably be disappointed from time to time. When adverse events occur, the goal is not to save face or to prove that the fault is someone else’s (such as the referring physician’s office or the scheduling desk) but to express regret, emphasize the opportunity to learn from the experience, and describe any changes that are being made to improve future performance. By reporting back at some point, the patient sees that the organization and its leadership are truly committed to listening to patients and putting their concerns and suggestions to work to improve the quality of care. CONCLUSION In Mark Twain’s lecture notes on Huckleberry Finn, he wrote, “A sound heart is a surer guide than an ill-trained conscience” [1]. A similar principle applies to handling tense interpersonal situations. We can try to memorize all sorts of tactics for dealing with them, but ultimately how we act is less important than who we are, and what we make people do is less important than how we make them feel. If we are genuinely committed to working with others to discover and pursue shared goals and mutual interests, and if we genuinely value them as
834 Invisible to the Eye
human beings, then many situations that start out as conflicts can be turned into collaborations that build stronger and richer long-term relationships. The overarching objective is to move from a paradigm of conflict, circumvention, and competition to one that emphasizes communication, collaboration, and commitment. Doing so may not always be possible, and in some cases the appropriate course of action may be to terminate the relationship. In general, however, the goal should not be to win at the other’s expense but to identify shared objectives and build a relationship that is enduring, effective, and mutually beneficial. Keeping one’s cool in such situations is less a matter of simply resisting destructive impulses than making sure to view the situation from a higher, more constructive,
and longer term perspective. In most cases, the ultimate enemy is not the other party, nor even emotions such as fear or anger, but insufficient curiosity about what has happened and a lack of desire to put its lessons to use in building better relationships. REFERENCES 1. Hutchinson S. Mark Twain: critical assessments. New York: Routledge; 1993.
5. Andrews LB. Conflict management, prevention and resolution in medical settings. Physician Exec 1999;25:38-42. 6. Jason PC, Lucy AE, Theodore SS. Consultants’ conflicts: a case discussion of differences and their resolution. Psychosomatics 2008;49:8-13. 7. Sharyl BS, Ruth ST, Minnie LP. Resolving conflict realistically in today’s health care environment. J Psychosoc Nurs Ment Health Serv 2001;39:36-45. 8. Curtis KA. Attributional analysis of interprofessional role conflict. Soc Sci Med 1994;39:255-63. 9. Gunderman RB. Complaints. J Am Coll Radiol 2004;1:630-1.
2. Ilan Y, Shoham C-H, Maxim M. Spurious consensus and opinion revision-why might people be more confident in their less accurate judgments. J Exp Psychol 2009;35:558-63.
10. Ury W. Getting past no: negotiating with difficult people. New York: Bantam; 1991: 149-53.
3. Constance AN, Marshall HB. Control structure and conflict in outpatient clinics. J Health Soc Behav 1972;13:251-62.
11. Berlin JW, Lexa F. Negotiation techniques for health care professionals. J Am Coll Radiol 2007;4:487-91.
4. Gerardi D. Using mediation techniques to manage conflict and create healthy work environments. AACN Clin Issues 2004;15: 182-95.
12. Otero HJ, Nallamshetty L, Rybicki FJ. Interdepartmental conflict management and negotiation in cardiovascular imaging. J Am Coll Radiol 2008;5:834-41.
Richard B. Gunderman, MD, PhD, Indiana University School of Medicine, Department of Radiology, 702 Barnhill Drive, Room 1053, Indianapolis, IN 46202-5200; e-mail: [email protected].
RICHARD B. GUNDERMAN, MD, PhD
From Conflict to Collaboration Richard B. Gunderman, MD, PhD, Arthy Saravanan Anger is like acid that does more harm to the vessel in which it is stored than to anything on which it is poured. —Mark Twain [1]
Radiologists sometimes encounter tense interpersonal situations of one type or another, yet few have any formal training in how to manage conflict. Consider the following scenarios. A referring physician storms into the radiology reading room. “What is wrong with you people? Do you have any idea how long my patient has been kept waiting? Over an hour! And for what? A simple chest radiograph! What kind of way is this to run a radiology department? Believe me, the hospital CEO is going to hear about this first thing tomorrow morning!” A department chair receives a phone call from an angry staff member. “I just heard that we are not getting raises again this year. I can’t believe it! We work as hard as any other group of radiologists, but what reward do we get? It just isn’t fair, and this is the last straw. I am going to start looking for another position, and I intend to encourage others to do the same.” A radiologist is called to see an upset patient. “I am so mad at your department. I drove over 2 hours to get here, and I had to take the day off work. When they finally brought me into the room for the exam, the technologist asked a few questions, called the radiologist, and they decided that I was scheduled for the wrong exam. Now I must come back tomorrow. Don’t you people have any respect for your patients’ time?” Such situations may involve not only referring physicians, colleagues, and patients but also technolo-
gists, nurses, and hospital managers, among a host of others. Radiologists may be the best lesion detectors and differential diagnosticians in the world, but if they do not handle such tense situations effectively, everyone is liable to suffer. To do better, radiologists need to recognize that just like other professional responsibilities, responding effectively to such situations requires knowledge, skill, and judgment. In this column, we outline different paths radiologists can follow in responding to potentially tense situations. Although these approaches do not exhaust all possibilities, they provide a convenient model for thinking about the basic issues at stake and help illuminate alternative visions, strategies, and tactics for handling interpersonal problems more effectively. These approaches are not mutually exclusive, and radiologists may move from one to another. Moreover, some conflicts involve more than two parties, and the approaches outlined here would need to be adapted accordingly. CONFLICT We define a conflict as a disagreement that one or both parties construes as a win-lose situation. For party A to win, party B must lose, and for party B to win, party A must lose. The problem with this approach is that it treats disagreements as zero-sum or negative-sum situations, in which the only way for one party to gain is for the other to give up something. People who see conflicts in these terms are unlikely to look for solutions that might benefit both parties. When both parties treat a disagreement as a conflict, they imme-
© 2010 Published by Elsevier Inc. on behalf of American College of Radiology 0091-2182/10/$36.00 ● DOI 10.1016/j.jacr.2010.08.003
diately begin to disregard the other party’s interests, simply assuming that the other’s claims are unimportant and not worth worrying about. When we operate from such a mind-set, we are likely to think, talk, and act in ways that imply loss by the other party as a foregone conclusion [2,3]. Each party finds itself in a mentality of “eat or get eaten,” which tends to short-circuit possibilities of cooperation and building a better long-term relationship. To avoid falling into a conflict-ridden mentality, radiologists need to guard against the temptation to paint other parties— whether referring physicians, colleagues, or patients—as opponents or enemies [4]. Generally speaking, no one deserves to be seen as the bad guy. CIRCUMVENTION A synonym for circumvention is avoidance. A common approach to frustration and anger among physicians, circumvention may in some cases prove helpful in lowering the levels of tension [5,6]. But circumvention is generally not the best strategy, in part because it often only postpones the inevitable and may in some cases merely cause levels of tension to escalate. The crucial question is not, “What course of action would produce the least discomfort for me?” Instead the question should be, “What decision would be best for our organization, our patients, and our community, and what do we need to do to promote their interests?” A key means of preventing conflicts is to invest in relationships. If a problem arises between two colleagues who already enjoy a strong 831
832 Invisible to the Eye
working relationship, they are much less likely to adopt an aggressive win-lose mentality in attempting to resolve it [7]. But key to building relationships is honest and open communication, and the parties involved need to be sufficiently secure in their relationship to trust that they can share concerns and even complaints with one another. COMPETITION We use the term competition to refer to situations in which one or both parties seek to use a particular disagreement to shift the balance of power in their favor. Such a perspective may prevent one party from even grudgingly admitting that there is merit in the other’s perspective. An adverse outcome of a competitive approach to disagreement is capitulation. In this case, one party simply surrenders and accedes completely to the other’s demands. Yet the outcome may be unfair to both parties. Merely resolving a dispute should be a lower priority than reaching a just outcome that all parties can live with. Moreover, capitulation may engender deep and long-lasting resentment, leaving one party feeling unfairly taken advantage of. Finally, capitulation deprives both parties of the opportunity to improve their negotiation skills. The opposite of capitulation is conquest. The aim of conquest is to gain control over the other party. One way of doing so is through a massive show of force. Another is by trapping the other party. A shrewd conqueror may accept the loss of a battle to win a war, by getting the other party to betray its core principles. Once such a betrayal occurs, trust between leaders and their colleagues is lost, and it can be difficult or impossible to restore [8].
CONVERSATION To turn the corner from conflict to cooperation, it is necessary to move from win-lose to win-win. But before we can know the other party’s interests, we need to spend some time getting to know them. And this means listening to them. Listening is an art. It means not just being quiet but responding to what others are saying, asking questions, making the effort to restate what we think we are hearing, and acknowledging when they have a valid point. Every complaint is an opportunity to gain a deeper insight into how someone else sees our daily work [9]. By moving from a perspective of competition to one of conversation, we naturally tend to lower the temperature in the room by letting the other party know that they matter to us as persons. Knowledge is empowering, and by making the effort to understand another person’s point of view, we help transform antagonism into cooperation and lay the groundwork for partnership [10]. In this respect, radiologists who find themselves confronted with aggression can often assume the role of educators, not by lecturing but by serving as a role model of how to handle conflicts in a more fruitful fashion. COLLABORATION Conversation is a necessary condition for collaboration. When we adopt a collaborative perspective, we continue seeking to understand the other party’s point of view, but we move from theory to practice, asking questions that are intended to help solve problems [11]. One collaborative approach that can prove highly disarming is to ask the other party’s advice: “If you were in my shoes, what would you do?” It is not always possible to begin collab-
orating in the midst of a heated discussion, but the radiologist’s every word and gesture can be shaped by a longer term effort to transform combatants into collaborators. The goal is not just to reach a resolution of the problem at hand but to work together in doing so. In this sense, the problem can become more of a blessing than a curse because it serves as an opportunity for the parties to begin to talk, imagine, and act together. To operate from a competitive perspective is to sell ourselves short. It means always putting ourselves first. It increases our tendency to think and act selfishly and without regard for the legitimate needs and interests of others. On the other hand, pursuing the possibility of collaboration tends to foster the development of important virtues, such as the capacity to see things from others’ points of view, to approach situations from the standpoint of fairness and mutual benefit, and to subordinate our narrow, short-term impulses to the pursuit of greater long-term objectives. COMMITMENT Commitment asks the problem solver to approach the dispute as an opportunity to build better relationships and organizations. The goal is not just to work together to resolve the point of contention but to do so in such a way that both parties achieve a higher level of mutual commitment. If we expect from the other party nothing but a “kill or be killed” mentality, then we will rarely be unpleasantly surprised. But if we have been working hard to take the high road and the other party suddenly shifts to the low one, the door is opened for grave disappointment and even betrayal. Enhancing commitment requires us to adopt longer term, more com-
Invisible to the Eye 833
prehensive, and deeper objectives with which to approach disputes [12]. We do not want to crush or embarrass the other party, leaving them feeling worse about themselves and their work. We do not want to bring out their worst. Instead, we want to help them to rediscover and act in accordance with their better selves, adopting courses of action that they can be comfortable with and even take pride in. Instead of spawning an enemy who will always rejoice in our downfall, we aim to create a trusted colleague, even a friend whom we can count on in times of trouble. CASES How might radiologists use these categories in navigating tense situations? Here are examples of how a savvy radiologist might respond to the frustrated individuals described in this article’s opening. Irate Referring Physician “Thanks for taking the time to come and meet me in the reading room, Bill. I know you are busy, and I am grateful that you took the time to visit in person. You are clearly upset about the amount of time that has elapsed since you sent the patient to our department, and I don’t blame you. An hour does seem like a long time. Let me look into this to make sure that we understand the situation accurately, and then let’s commit to working together so that we can prevent a similar problem in the future.” In this case, the delay in service may be radiology’s fault. On the other hand, the fault may lie elsewhere. Perhaps transporters were slow to bring the patient to the department. Or perhaps the patient chose to stop for a snack on the way. The problem may even lie with the requesting clinic itself. Perhaps the order for the examina-
tion was never entered, and technologists have spent the past 45 minutes trying to get the clinic to place it. Failing to do some fact finding can result in misallocation of blame and failure to learn important lessons. Irate Colleague “Thanks for calling me about this, Mary. I can understand your frustration. I, too, would like to be getting a raise this year. Your concern makes me think that we should be doing a better job of sharing information about our practice’s financial status and the various pressures we are experiencing that have made providing raises problematic. I could use some help in devising a way to do this more effectively. Before you seek other employment, why don’t you and I meet again soon to discuss this? I bet you would come up with some ideas that would benefit us all.” Group members have a strong interest in the financial status of the organization, and it is important that such information be shared, so that everyone operates with a clear picture of where things stand. By treating such a complaint as an opportunity to enhance communication and draw on the problem-solving capabilities of a talented colleague, a leader can turn potentially ugly situations into formative and beneficial experiences. In doing so, the focus needs to be on understanding all of the group’s resources and all the rewards it offers its members. Allowing the conversation to focus exclusively on money can implicitly devalue other worthy objectives and demoralize everyone. Irate Patient “I can definitely see where you are coming from, Mr Smith. You feel like you wasted the better part of a day because the wrong examination
was ordered. I am sorry about this. I don’t know at the moment how this happened, but let me look into it and report back to you on your return visit. We are committed to respecting our patients’ time and ensuring that visits to our department go as smoothly as possible, and I want to make sure that we learn from this experience so that it will not happen again to you or anyone else. To make your return visit as convenient as possible, let me arrange for our department to cover your parking and meal costs.” In an organization as complex as a busy radiology department, patients will inevitably be disappointed from time to time. When adverse events occur, the goal is not to save face or to prove that the fault is someone else’s (such as the referring physician’s office or the scheduling desk) but to express regret, emphasize the opportunity to learn from the experience, and describe any changes that are being made to improve future performance. By reporting back at some point, the patient sees that the organization and its leadership are truly committed to listening to patients and putting their concerns and suggestions to work to improve the quality of care. CONCLUSION In Mark Twain’s lecture notes on Huckleberry Finn, he wrote, “A sound heart is a surer guide than an ill-trained conscience” [1]. A similar principle applies to handling tense interpersonal situations. We can try to memorize all sorts of tactics for dealing with them, but ultimately how we act is less important than who we are, and what we make people do is less important than how we make them feel. If we are genuinely committed to working with others to discover and pursue shared goals and mutual interests, and if we genuinely value them as
834 Invisible to the Eye
human beings, then many situations that start out as conflicts can be turned into collaborations that build stronger and richer long-term relationships. The overarching objective is to move from a paradigm of conflict, circumvention, and competition to one that emphasizes communication, collaboration, and commitment. Doing so may not always be possible, and in some cases the appropriate course of action may be to terminate the relationship. In general, however, the goal should not be to win at the other’s expense but to identify shared objectives and build a relationship that is enduring, effective, and mutually beneficial. Keeping one’s cool in such situations is less a matter of simply resisting destructive impulses than making sure to view the situation from a higher, more constructive,
and longer term perspective. In most cases, the ultimate enemy is not the other party, nor even emotions such as fear or anger, but insufficient curiosity about what has happened and a lack of desire to put its lessons to use in building better relationships. REFERENCES 1. Hutchinson S. Mark Twain: critical assessments. New York: Routledge; 1993.
5. Andrews LB. Conflict management, prevention and resolution in medical settings. Physician Exec 1999;25:38-42. 6. Jason PC, Lucy AE, Theodore SS. Consultants’ conflicts: a case discussion of differences and their resolution. Psychosomatics 2008;49:8-13. 7. Sharyl BS, Ruth ST, Minnie LP. Resolving conflict realistically in today’s health care environment. J Psychosoc Nurs Ment Health Serv 2001;39:36-45. 8. Curtis KA. Attributional analysis of interprofessional role conflict. Soc Sci Med 1994;39:255-63. 9. Gunderman RB. Complaints. J Am Coll Radiol 2004;1:630-1.
2. Ilan Y, Shoham C-H, Maxim M. Spurious consensus and opinion revision-why might people be more confident in their less accurate judgments. J Exp Psychol 2009;35:558-63.
10. Ury W. Getting past no: negotiating with difficult people. New York: Bantam; 1991: 149-53.
3. Constance AN, Marshall HB. Control structure and conflict in outpatient clinics. J Health Soc Behav 1972;13:251-62.
11. Berlin JW, Lexa F. Negotiation techniques for health care professionals. J Am Coll Radiol 2007;4:487-91.
4. Gerardi D. Using mediation techniques to manage conflict and create healthy work environments. AACN Clin Issues 2004;15: 182-95.
12. Otero HJ, Nallamshetty L, Rybicki FJ. Interdepartmental conflict management and negotiation in cardiovascular imaging. J Am Coll Radiol 2008;5:834-41.
Richard B. Gunderman, MD, PhD, Indiana University School of Medicine, Department of Radiology, 702 Barnhill Drive, Room 1053, Indianapolis, IN 46202-5200; e-mail: [email protected].