This is a tricky area to cover as it can be challenging to us both personally and professionally when things don’t go well with a colleague, particularly when we know that this might impact patient care and/or our own mental health. The longer these negative interactions go on, the more likely they are to significantly impact on outcomes for our patients, our colleagues and ourselves.

From personal experience there are three golden rules to consider when you have a bad interaction with a colleague:

Bullying and harassment should never, ever be tolerated. 
It is hard to speak up sometimes. Especially when it is a singular episode with hierarchies of power involved and no witnesses. Your response may range from simply documenting the event somewhere secure, so that you have a contemporaneous record of what happened and who else may have been involved to support any future decisions you might make, all the way up to formally speaking up. If you do escalate, exercise careful thought. The first step should be an informal chat with someone in authority whom you trust, or who has responsibility for your wellbeing. Where you go from there will depend on the circumstances of your situation, but if these behaviours are persistent, you will have to find a way to deal with it, for yourself and for others.

There might be something else going on in their life
When I have an unexpectedly difficult interaction with a colleague, the first thing I remind myself is that very few people come to work to do a bad job and to fight with their colleagues. If it is happening, it is more likely to be something going on in their life that has nothing to do with you. Perhaps something is going on in their personal life, perhaps they just had a difficult interaction with someone themselves and you just happen to be the next person they see, or perhaps they are suffering chronic stress. If you’re on the receiving end in these scenarios, it is rarely personally directed at you, you just happened to be the person in the wrong place at the wrong time. If you can find it within you to not take it personally, you might be able to help your colleague to recognise that whatever is driving their negative approach is impacting on others, and needs to be addressed. A simple sentence like ‘This interaction hasn’t gone well. Can I just check if everything is ok with you?’ or even something as simple as saying ‘ouch’ when something hurtful is said, can help someone to recognise that what they are saying, or how they are saying it, is impacting negatively on someone else.

Be careful with your emotions
Reacting to something in the moment, when emotions are high and fingers are ready to be pointed, can be like pouring oil on a fire. Remember what it is that you came into the interaction for, get that done and then withdraw. If you cannot let it go in the moment, then try to express your feelings in broad terms and make a plan to come back to the situation later to discuss it. ‘I feel like this interaction hasn’t gone very well, and I’d like to come back to you later to talk to you about it’. Their response to this will tell you everything you need to know. If they immediately apologise, it was never about you and you just got caught in the crossfire from something else. If it’s a ‘yes, let’s talk this through later’ then it’s hopefully a relationship which can be rescued with careful debriefing and feedback. If it’s a ‘No’, then cut your losses, document your interaction, speak to colleagues and take care with this individual in future.

Consider different styles of communication:
There are as many ways of thinking about communication styles as there are people, but I have often found the following model to be helpful:

To use this model, consider your feelings as an interaction proceeds. Are you feeling ok and comfortable with this? Does the other person seem ok and comfortable with this? Are we maintaining open and respectful communication or is one of us shutting the other one down? Is there defensiveness or conflict bubbling up? Are disagreements tolerated and discussed, and do both sides contribute to the final outcome?

The aim is for most communication to adopt “Assertive Communication”.

Aggressive communication:
This is directive communication which might be necessary to get something done quickly for example, during an emergency. However, it might be worth picking it up later with other parties to discuss why it was necessary and why it was used. If you recognise that you are communicating aggressively towards someone else, take a moment to acknowledge that perhaps you are being too directive and explain why: ’Ok, I recognise that I am pushing hard for this, but this is why..’. The other trick is to stop and ask some open questions with a frame such as, ‘I realise I’ve done all the talking and directing, is there anything you wanted to add or say, particularly anything you think I’ve missed or overlooked?’ In an emergency, this can be helpful to identify issues you may have missed.

If you’ve been communicating aggressively with specific people or teams for a while, it’s going to take a long time to unpick this.

Submissive communication
If you recognise that you are being submissive and you have information or opinions that need to be conveyed to contribute to a good overall outcome, you need to find a way to speak up. One such tool is called Graded Assertiveness, where you gradually increase the assertiveness of your communication to get something across to someone who perhaps isn’t listening. It’s remembered by the acronym PACE.

• Level 1: Probe. Ask questions, perhaps from a point of view of ‘Could you teach me why you’re doing that..’ ‘For my education, why is it that..’. Try to find out why the other person is thinking or doing something different to what you think or would do. This process may help both of you to recognise the flaws in your thoughts or actions that are leading towards a bad outcome without you having to directly challenge the other person.
• Level 2: Alert. Slightly more assertive, but having probed you should have a good idea why the other person is doing/saying the things they are. You can now perhaps alert them to the piece of information they are missing that would change what they are planning. ‘Are you aware that X is allergic to Y?’ ‘But the CXR shows X instead of Y doesn’t it?’
• Level 3: Challenge. Fully Assertive. They haven’t taken on board the information you’re offering and you’re now more confident that they are wrong and you are correct. You need to tell them that what they are doing is possibly incorrect and could end badly. ‘Mr X can’t have that drug because of condition Y, so you could make him sicker’
• Level 4: Emergency Stop. Assertive to the point of being aggressive. Taking control. You know that what the other person is doing is wrong and potentially dangerous. You need to stop them from doing it immediately to prevent harm. ‘Please stop. I don’t think this is the right thing to do and you’re making an unsafe decision. We need to review this or get another opinion now.’

The danger of not moving effectively away from submissive communication towards assertive communication, or being persistently dismissed by aggressive communicators, is that over time, our communication style may instead settle into a passive-aggressive style. This is not healthy nor effective.

Speaking in terms of feelings
Another technique to help communicate in difficult scenarios is to speak in terms of what you know or what you feel, and avoid commenting directly on what the other person is saying/doing and by extension what you judge them to be thinking. If you speak in terms of your feelings, they can’t tell you that you are wrong, and hopefully, you won’t make them defensive by saying things about their actions that they can immediately disagree with.

• Instead of ‘You’re doing X wrong’ you could say ‘I know if I was doing that, I’d do it this way, can you explain the rationale for your method?’
• Instead of ‘You’re being very rude and obstructive!’ you could say ‘When you speak to me this way, it makes me feel like I’m being dismissed or that I’m an idiot, are you aware of that?’

Both of these approaches allow the other person to perhaps explain their behaviour and come to recognise what has gone wrong, instead of immediately putting them on the defensive where their first instinct might be to deny/disagree with your statement, leading towards conflict and a bad outcome all round.

This is also the trick of saying ‘ouch’ when someone is being rude to you. Reminding them that their words and actions have consequences for others without directly challenging them can be a way to help someone who is stuck in an aggressive or angry mindset to switch out of it, and recentre.

When it still doesn’t work
All of these methods and techniques rely on the basic principle that both parties in any communication are trying to do their best in any given situation and that there may be any number of external or internal factors getting in the way of that. There will sadly be situations in your career where you encounter individuals who will remain difficult, rude and obstructive despite any change in method or technique that you employ. The consistent thing about these people will generally be that everyone is aware of this, and avoids conflict with them, sometimes even just avoiding them entirely. If you are dealing with people like this, you must try where possible to recognise that any difficulty in communicating with them is nothing really to do with you. You may need to remove any ego from your dealings with them to avoid feeling annoyed, angry or upset by their behaviour. If you know you’re heading for a difficult interaction with someone like this, there are thing you can do to prepare:

• Write down the points you want to make, so that regardless of how difficult the communication gets, you have something to refer to, and you can ensure you make the points you want to make. If it completely collapses you can always hand over your points and walk away.
• Arrange a witness or ensure it is done in a public space.
• Avoid any personal comments or attacks at all costs ‘Be the better person’.
• Try not to slip into passive-aggression (It can be VERY tempting).
• Debrief with someone you trust afterwards, and document everything contemporaneously
• Be prepared to speak up. The few individuals who are like this, get away with it because no individual is prepared to take on the stress of challenging them or reporting them. Speaking up and whistleblowing processes are gradually getting better and stronger.

The final point I would make is about ourselves. We are often not aware of the acute and chronic stress that we carry and how it may impact on our behaviour and communication. It may be that WE are the difficult colleague. If you’re having a series of difficult interactions, either in a single shift, or over a longer period, it’s worth checking yourself, are you perhaps part of the problem? This can be a difficult thing to explore and recognise. Discussing things with seniors or colleagues may open up insights for you. ‘I keep having difficult interactions with X, or when I’m doing Y, are you aware of anything I’m doing or saying which might be contributing to that?’.

Doing multi-source feedback with groups of colleagues where communication can be challenging is another option to be approached with the support of your education supervisor. You don’t want to do this without their support as there is obviously a chance for negative responses which may influence further reports of your training progression.

If you are dealing with acute or chronic stress, seek help. Left untreated, burn out, mental health issues and poor outcomes for you, your team and your patients are all on the cards. There are individuals and organisations, both in your local area and in your region who are intended to support us and our colleagues at times like this. There is no benefit to you trying to cope on your own, and you’d be amazed how many of your colleagues and seniors have been through something similar and have surprising stories and words of wisdom for you.

Written by Tom Simpson (Respiratory Consultant)