I’m sure we’ve only worked with a difficult colleague before and I’m sure we can name one person in our mind that has challenged us. In the UK, situational judgement tests have been part of our curriculae for the last few years which has been used as psychometric testing but have we ever  really been taught how to deal with someone who just rubs us up the wrong way!? In my role as Chair I do meet a lot of people and I have to work with a lot of people and it was going to be inevitable that I would not see eye-to-eye with everyone.

My friend Arnoupe, Keita and I ran a workshop in Seoul about difficult colleagues which I thought I’d write up here as it is relevant to our day-to-day practice. We’re focusing on the “disruptive” doctor here (where personal conduct impairs patient care) which should not be mistaken for an “impaired” doctor (doctor who cannot perform professional duties because of a mental or physical illness) and definitely not to be confused with someone who just has a different opinion to you. These can lead to real challenges if these situations lead to a breakdown in trust, clinical judgement and interpersonal relationships.

In this paper that Arnoupe found (Garelick et al), it talks about the 3 C’s.

• Has the person taken an active part CAUSING the problem?
• Does the person CONSISTENTLY cause problems?
• Is there a CONSENSUS that this person is generally causing problems?

I find this a helpful way to work through whether I just don’t like someone or if they have a challenging persona and I spend a lot of time in reflective practice unpicking my own emotions.  There’s so many parallels that can be drawn with difficult encounters (apparently it’s not PC to call it heartsink patients anymore) where trying to find that middle ground can be challenging when there’s transference and counter-transference going on. One can argue that conflict is a natural outcome of human interaction.

The paper goes onto give the following advice

• Don’t avoid the issue hoping it will go away
• Try to see the difficulty from the other person’s viewpoint
• Have an informal discussion over coffee with a friend or colleague
• Share the problem with an independent or trusted colleague
• Find time to deal with the issues
• Find a local supporter/mentor
• Be prepared to learn from your mistakes

Well, that’s rather easier said than done!

Thomas and Killman suggest that there are five ways of managing conflict and maps them out depending on levels of co-operation and assertiveness.  It’s also interesting to note that our conflict-managing styles may change  depending on how much stress we are under.

• Competing – high assertiveness, low co-operation leading to a win-lose scenario
• Collaborating – high assertiveness, high co-operation (win-win)
• Compromising – medium assertiveness, medium co-operation (win some lose some)
• Avoiding – low assertiveness, low co-operation (lose-lose)
• Accommodating – low assertiveness, high co-operation (lose-win)

This is my own opinion but I think we spend too much time in the West celebrating assertiveness, which is useful in many but not all situations. Learning from my Japanese colleagues (where relationships and the wider group are valued more than self and assertiveness), there are many situations where avoiding and accommodating is the best way forward for team dynamics and, this may be cultural but, I am a big believer in picking my battles.

This is also outlined in Hall’s cultural models where cultures are divided into high context and low context. A high context culture like Japan relies on implicit communications where there is more emphasis on what is not being said that what is. What I found interesting with this model was this concept of the internal locus of control and failure. If something doesn’t go right, a Japanese colleague is more likely to blame themselves than their Western colleague who may blame others or the situation. It can be rather comical, as a bystander, when something goes wrong in a Japanese team and everyone rushes in to apologise. It’s less funny when you watch a low context team blame each other!

	High Context	Low Context
Messages	Covert, implicit, metaphors, reading between lines	Overt, explicit, clear, simple
Control and failure	Internal	External
Non-verbal communication	High	Low
Expression of reactions	Reserved	External expression
Level of commitment to relationships	Relationship more important than task	Task more important than relationship
Flexibility of time	Flexible. Process more important than product	Product is more important than process. Time is therefore organised.

Another thing that I always have to keep in mind when working cross-culturally is how people express emphasis in language. Certain languages, like British English and Japanese will use euphemisms in order to make a point (“She’s not my favourite person!“) whereas some other cultures will dial the intensity of a language up (“She is the most awful person ever!”). If I get rubbed up the wrong way when someone gets over-animated with me, I know it’s my problem not theirs. This is really helpful when trying to hear what they are trying to say under all that superlative language.

So how about some practical tips? Two things that may help is having a mediator and also instigating organisational changes.

1. Mediator – Having a third party present can often stop things from escalating and also is an independent pair of eyes. I’m lucky to have a good team overall but I often rely on other people to be present if my gut feeling tells me that something is not quite right. Better to prevent a problem from arising than fire-fighting.
2. Organisational change – Claire (VDGM president) taught me this. Sometimes these conflicts may lead to the uncovering of gaps in the organisation that lead to such conflicts happening. Does a new protocol need to be implemented? Does a new method in team decision-making need to be considered? Although bending and breaking rules is enjoyable, having them there in the first place manages expectations and avoids arguments and hurt feelings.

It’s important to remember that conflict management is not the same as conflict resolution and there has to be acceptance that sometimes, one has to agree to disagree for the greater good. I am by no mean an amazing communicator nor am I without conflict but over the last year and a half, as Chair, I have got to know myself better and therefore what my core values are. A great quote from Brené Brown is “blame is the discharging of discomfort and pain and has an inverse relationship to accountability. Accountability is a vulnerable process.” Click here fore the full video. So learning not to blame and instead looking inside ourselves to find out what our unmet needs are is an essential part of this process.

So now that we understand the theory, we just have to put this all into practice… 😳

Thanks to Arnoupe and Keita for their great ideas, hard work and presentation skills at the WONCA conference. Thanks to all my long-suffering confidantes who have allowed me to rant about a multitude of things. And finally, thanks to Cemal (Deputy Chair) and Claire (VDGM president) for sharing lessons in leadership and team management with me.

References

de Leon J, Wise TN, Balon R, Fava GA. Dealing with Difficult Medical Colleagues. Pyschother Pyschosom 2018; 87:5-11

Garelick G., Fagin L. Doctor to doctor: getting on with colleagues. 2005. Advances in Pyschiatric Treatment, 10, 225-232 in Royal College of Psychiatrists. Dealing with Difficult Colleagues [Online] Available at: www.rcpsych.ac.uk/workinpsychiatry/psychiatristssuportservice/difficultcolleagues.aspx