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Medical Student Perspectives: Interpersonal Communication: Resolving Conflicts

Heraclitus wrote in On the Universe, “You could not step into the same river twice; for other waters are ever flowing on to you.” Medical students are ever the product of our rapidly swirling experiences–no two events are alike. So are the encounters we have with our patients, classmates, residents, allied health-care staff, and attendings. Four principles of interpersonal communication may allow insight into a more efficient manner in resolving the ebb and flow of conflict: interpersonal communication is intricate, irrevocable, inevitable, and contextual. Because of variance involving both personality and circumstances no single solution or formula can be applied to all arising conflicts; however, if we build upon a foundation of patience, understanding, integrity, and empathy, we may better weather difficult situations.

If you would, allow me to indulge in my own experience and thus illustrate. I attend medical school in a region of the country with relatively little ethnic or racial diversity. A young immigrant woman presented to my internal medicine service in excruciating pain. She had battled many previous crises caused by a hereditary blood disorder. Due to her transient social status, she had a record of visiting many physician offices around the valley seeking pain relief. The team resident doubted the reality, severity, or urgency of her condition. In my mind, there were great risks which may have led my team to misunderstand her suffering due to differences in our culture, gender, ethnicity or race, and relative inexperience in treating this disease. I felt that we needed to aggressively manage the pain contrary to my resident’s opinion. At this point, I had a few options. I could acquiesce and focus on other clinical duties or tactfully (or tactlessly for that matter) demonstrate my dissension. During rounds, I presented several papers to our team and made what I hoped to be a compelling case for my patient; while also recognizing the concerns of my resident, who was certainly more experienced and knowledgeable than I.

This was stressful and required meticulous selection of words. In the end, my suggestions were not adopted into the patient’s care-plan. Did I lose overall? Absolutely not! I learned from quality, peer-reviewed literature about a common medical problem, demonstrated to my team that I could discreetly disagree, and most importantly made a case to more fully alleviate human suffering. To me this was a sticky complicated situation, primarily because I knew my resident’s thoughts before I presented my plan to the team attending. The words I spoke were irrevocable — that is to say, once I had spoken the words I could not take them back. Inevitably, I had to either accept or reject my resident’s plan. Understanding given to my words was highly contextual. The better the team knew me as a both a student and a person, the more likely my message would be fully understood. The chance that my words would be successfully received by my team members depended highly on cultural and psychological similarities.

Many other encounters existed during my rotations. I have acquiesced to “easy ways out” and blundered through many an attempt to share a tasteful difference of opinion. On that note, during my class’s first year of medical school, we collectively developed a code of professionalism to help us navigate through these medical conundrums. A portion of the preamble for our class code reads as follows:

  In the presence of ignorance, I will strive for knowledge.
When intolerance knocks, I will answer with patience.
May I always find time to care and make time to teach –
for that is a doctor.

 

To some these lines may be simple platitudes, but instead I’ll mark them as aptitudes, on my journey to become a physician.

Ryan VanWoerkom
Council of Student Members Representative, Midwestern Region
University of Utah School of Medicine, 2010
Email: ryan.vanwoerkom@hsc.utah.edu

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Back to June 2009 Issue of IMpact

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