Since it is the responsibility of the physiotherapist to manage challenging situations, it is important to know how to effectively resolve them. More importantly, how can you avoid the conflict to begin with? The components of a good working relationship include:
- Non-coercive influence
When establishing any working relationship, consider your own values, beliefs and expectations. Knowing yourself and particularly the things that frustrate you will help you to identify potential conflicts when working with clients and others. Consider how your own emotions and reactions may be impacting your ability to establish an effective working relationship with your patient.
You also need to understand your client’s beliefs, values and expectations. Take a moment to think about how you would feel if you were in your client’s position and acknowledge their emotions. Begin with the assumption that you need to know more. It is not required that you share the same values or beliefs to work well together. It is required that you accept and acknowledge the other person’s values, treat them as an equal and demonstrate respect.
When you cannot meet the client’s expectations (for example due to funding or time limits) it is best to discuss the situation as soon as it becomes apparent. Similarly, if your employer has policies about billing for missed appointments or providing treatment when patients are late for appointments, conflict can be avoided or minimized by discussing the policies early in the relationship before issues arise.
By establishing expectations that you are sure you can meet, and applying a philosophy of “under promise, over perform” you will increase your chances of avoiding conflict.
If however, you choose to tolerate situations arising from a patient’s unrealistic expectations or inappropriate behavior by hoping the patient’s behavior will change or the patient will cease treatment, you are not actively managing the situation and are not meeting the expectations for physiotherapists in Alberta.
There are many resources available to support professionals who wish to improve their communication skills. The DESC method of assertive communication (Appendix C) and the BLAST technique for complaint resolution (Appendix D) are two such examples.
Basic principles of effective communication include:
- Practice active listening.
- Focus on the issue rather than the individual.
- Limit comments to the issue at hand, rather than past conflicts.
- Avoid the words always and never.
- Monitor both your verbal and non-verbal communication.
- Use humor cautiously, respectfully and never at the expense of the other individual.
Although these tips may seem like common sense, Physiotherapy Alberta’s experience fielding complaints from patients and others suggest that a failure to apply these basic principles is at the heart of many of the patient complaints we encounter.
In many situations, inconsistent behavior can be more of a challenge than predictably poor behavior. When building working relationships, strive to model behavior that is:
- Takes promises seriously
When seeking reliability from others, remember to give trust when it is deserved and approach problematic behavior as a joint problem, asking “how do we fix this?”
Remember that your focus is not on winning an argument, but on developing a better understanding of the patient and their perspective and settling on a new consensus about the best course of action. In clinical situations, it is rare that there is a single best course of action. The principles of evidence-based practice require that a combination of research evidence, clinical knowledge and patient preferences are used to inform treatment decisions. The best course of action for any given patient is not always the gold standard of care, but rather the best possible combination of all three sources of knowledge.
Remember that because of your knowledge, skills and role in the relationship you are in a position of power. It is important that you work to decrease any power imbalances that exist between you and your patient, their family or other health-care providers by paying particular attention to what the patient’s preferences are. In doing so, you support patient-centered care and self-management, leading to better long-term patient outcomes.
Acceptance does not require that you agree with others’ values or approve of their conduct. It does mean that you treat others with respect and as equals and acknowledge that their views or values are what they are.
When you can’t build an effective relationship
There are times when it is appropriate for a physiotherapist to discontinue treatment even though a patient wants and needs continued care. Physical, verbal, sexual or emotional abuse have no place in a therapeutic relationship. If a physiotherapist perceives that they are at risk or are being abused by their patient, they have the right to decline to continue to provide treatment.
This is a circumstance where the physiotherapist’s employer (where applicable) should be involved in resolving the situation. Physiotherapy Alberta expects that employers will create and maintain healthy, safe work environments for their employees. This expectation extends to both physical and psychological hazards.
If the physiotherapist is discontinuing treatment, the Standards of Practice require that the physiotherapist (or his/her employer) discuss the situation with the patient, explain their decision, provide the patient with a list of other sources of similar treatment, and (when possible) assist the patient to find alternate treatment providers. Depending on the situation, it may be appropriate for the physiotherapist to provide a limited number of treatments until the patient can commence treatment elsewhere.
Adapted from a presentation by L-A. McFarlane, Center for studies in clinical education, University of Alberta.3