By appreciating the discourse of ADR theories, we begin to understand that language and cultural norms shape both individual and group behavior bringing them into conflict with alternative cultures. In addition, dynamics that significantly influence understanding and reaction to a conflict occur because of gender, socioeconomic status, and race.
In healthcare, we see all these factors combined with an effective hierarchical and authoritative sub cultural that dominates and frames the spectrum of conflicts, from simple miscommunication to the extremes of litigated disputes. Most of us approach conflict as a win – lose proposition instead of an integrative problem-solving collaboration, allowing us to work in concert with our opponent, improving both of our situations through a win-win proposition.
As expected from studies on human nature, when we achieve success through hard work, we expect autonomy, respect and authority. Without contempt or condescension, we are entitled to social gratitude and recognition, taking pride in our own efforts, commitment and accomplishment. When we demand respect and authority however, we are perceived as positional, defensive, arrogant and authoritative. We often ignore the knowledge and experience of our personal and professional circle. Practically speaking, trying to reject the team concept of healthcare integration and preserve hierarchical authority based upon institutional achievement, is a threat to quality patient management.
These behaviors are nearly universally rejected and constitute the foundation of dispute instigation in Medicine. Our willingness to be reflective in our own practice of communication and interaction with our colleagues at all levels of training is critical for our personal success, free from cognitive turmoil and dissonance, and in that success our professionalism will drive us to provide the highest quality of attentive patient care.
Academic analysis shows us that common dispositional demands from people in a traditional hierarchical system like healthcare results from their defensiveness and fear of having made a mistake, guilt and or fear of shame, as well as attribution errors (blaming others or the situation) from myopic approaches to problems. Practitioners have become so used to the conflict narrative in medicine that aggressive positional behavior and demands, occurring all around us, no longer register in our mind as emotionally driven by adverse parties. The provider becomes numb and distant to the emotional impact conflict has on ourselves and our closest relationships, both professionally and personally, from our adaptation to the intense clinical work space. However, not everyone in this work place is equally insulated, so the emotional and visceral consequences of heated discussions, yelling, and angry debate influences and stresses many in the field. Likely, it is also subliminally affecting us and fueling our malaise, burnout and antipathy toward the profession of medicine. The apathy we feel over a day in clinic or responsive anger to the 11pm call to clarify an order is founded in the impact of these daily angry disputes.
The conflict narrative causes replay event psychological fixation with our ever-improving clever positional responses, all disrupting peace of mind and a restful night’s sleep. At times this fixation is pathological, and we cannot quiet our mind and refocus our attention. We accept the dysthymic and depressive influence this has on our mood and behavior as we bury the distaste deep in our subconscious. These are fundamental conditions for post-traumatic stress disorder.