You are in your office meeting with an elderly mother, your patient, and her daughter. There is strong resistance from the daughter to a much needed treatment plan you are proposing for the elder mother. The elder mother wants the treatment, but is dependent on her daughter for care-giving and for financial decisions. You know she needs this treatment. Conflict: What do you do?
When in this situation most doctors misunderstand their role. Doctors generally see the solution to this scenario from the perspective of persuasion. The options are: either I convince the daughter that the treatment is needed, or I fail to convince the daughter and the patient goes untreated. This perspective focuses energy upon the persuasive power of the doctor and the resistance power of the daughter. Employing this perspective turns the discussion into a power struggle and increases the likelihood of failure because of the limitation of the techniques available using persuasion.
The only techniques available in persuasion are: shame, guilt, threat, punishment, and indifference.
Shame: “What kind of daughter are you to let your mom go through the debilitating pain she will have to suffer with this treatment?”
Guilt: “You do understand the amount of debilitating pain you will be forcing your mother to endure by denying her this treatment?!”
Threat: “If you do not approve this treatment plan your mother will suffer terrible, debilitating pain.”
Punishment: “You can be the one to explain to your mother why she is in so much pain. And if she asks me, I will tell her it was your decision to withhold treatment.”
Indifference: “I don’t have to live with the pain. I have plenty of patients who want my help.”
Using these techniques will be more likely to invite an argument than a resolution. The road to resolving this conflict is not persuasion, but exploration. The doctor who understands his or her role as explorer will succeed at resolving this conflict. Resolution resistance is softened not by driving persuasion skills through it, but by exploring around it. You will need to explore the daughter’s resistance before she will follow you to the end of the road you are asking her to take.
When exploring Resolution Resistance what do you need to know?
Three Causes of Resolution Resistance
When I work to resolve conflict there are three things I commonly notice that cause resolution resistance: fear, discomfort, and a single solution mindset.
Fear drags many fights into indecision and resistance.
1) Fear of what others might think.
We go into a conflict situation with the moral support of those whom we have turned to for support and advice: friends, neighbors, relatives, siblings, co-workers, people whose opinion we value and depend on. What will my other siblings think if I approve this proposed treatment plan? Will I be able to defend my decision to them after all the things I said about this doctor? What will I have to complain to my friends about if my mother is no longer such a burden to me?
2) Fear of making a decision I might regret later.
What if I overlook something and end up settling for less than she could get, less than she deserves? What if there is a better treatment plan out there from another doctor? What about that doctor my neighbor was telling me about? What about the treatment plan that killed my friends father last year? Can I trust myself not to miss something here? I have to live with my decision the rest of my life and my siblings may never forgive me for what I choose.
3) Fear of loss.
Fear of loss is often at the heart of a conflict. Whether the loss is objective or the loss is subjective, people engage in a conflict to either: prevent a loss, lessen an ongoing loss, or attempt to regain something that was lost. The opposite of loss is gain. In every conflict there is a loss/gain ratio working in the decision making process of the combatants. When the daughter decides to end this conflict it will be because the solution will, in the daughter’s mind, improve something. She will resolve this conflict when her gain outweighs her feared loss.
Resolution resistance and fear can take many forms and expressions and be exhibited in a variety of ways, standing in the way of a resolution decision. A doctor with conflict resolution skills can effectively address spoken and unspoken fears and facilitate resolutions beneficial to patient, staff, and doctor.
Comfort Zones, Discomfort and Decision Making
Discomfort is another common cause of resolution resistance. Discomfort results what someone finds him or herself outside of their comfort zone. Each of us has different boundaries defining our personal comfort zone. What makes one person uncomfortable may not even cause another person to flinch. A doctor with conflict resolution skills must be aware of patient’s comfort zones knowing that discomfort could lead to resolution resistance.
A comfort zone is a compilation of one’s self image, habits, expectation, and familiarities. When outside our comfort zone, a powerful gravitational force pulls us back into our area of comfort. The farther outside our comfort zone, the greater the gravitational pull toward the familiar, the safe, the comfortable and the greater the resolution resistance, particularly around decision making in the medical arena.
When the daughter is outside of her comfort zone, then decision making will be difficult, triggering resolution resistance. She wants things to be the way they were. If she is new to the responsibility of care giving for her mother, then every conversation regarding her mother risks her being yanked outside of her comfort zone. Add anxiety, frustration, confusion to the dynamics of her decision making process then fear and discomfort are almost assured. It becomes obvious why persuasion tactics (shame, guilt, threat, and punishment) can only escalate resistance. Any solution made outside of a comfort zone may fail to reflect a clear perspective of the problem.
A Single Solution Mindset
The third common cause of resolution resistance is a single solution mindset. Each person comes to a conflict with what they consider a just and fair resolution in mind. Each person has an optimal outcome in mind. For the daughter, it may be someone else taking care of mother, someone else making this decision. For mother, it may be able to live pain-free with her daughter without feeling like a burden. For the doctor, it may be easing this patient’s pain and getting paid for services in a timely manner.
The characteristic of a single solution mindset is the intention to convince the other people in the room of the veracity, fairness, justness, and worthiness of his or her solution as the appropriate solution to this conflict. This disagreement lies at the heart of the stalemate. If they could all only agree upon one of the solutions, then there would be no more conflict; hence, the strong temptation to persuade rather than explore.
One reason there is a conflict, and decisions have to be made together, is because the three optimal outcomes seem incompatible. Each comes with a single solution in mind. They become stuck when any one person sees his or her solution to this situation as the best and only resolution to this problem, whether it is the doctor, daughter, or mother.
People’s single solution characteristically, by design, balance the scales of gain and loss in their minds. Their solution represents 100% gain and 0% loss. Unfortunately, this single solution often then proposes a 0% gain and 100% loss to the others in the conflict. The question is, “How to shift the weight of the scales away from the fear of loss, beyond the single solution that is creating resolution resistance, and onto key gains for each party?” The answer to this question is: exploration.
What Do You Explore?
The number one characteristic of a good explorer is he or she must ask a lot of questions. I will give you three questions I ask that will set the stage for you, the physician, as an explorer.
1) I ask them to tell me what they want.
They will state their single solution here. One way I like to ask this kind of question is: “If you could have anything you want, the best of all possible worlds, what would you ask for?” So the first question is designed to get their single solution out in the open. Once I have their solution on the table, I must explore some characteristics of this solution to try and determine what it will do for them.
2) I will ask, “Why do you want “this solution?”
There are two types of “why” questions: One “why” question wants to know the reasons behind something; the other “why” question wants to know the purpose for something. The explorer is asking, “for what purpose are you demanding this solution?” Inevitably, your person in conflict will answer by giving you the reasonableness of their solution (not the purpose for this solution). One way I like to ask this question is, “how will this help you?” I can take the “for what purpose” question deeper by asking an impact question.
3) Then, “What impact will it have, if you do not get this “solution”?
Often I can ask this same question, but from the opposite point of view. Instead of asking, “What impact will it have, if you DO NOT get this “solution”? I will ask, “What impact will it have, if you DO get this “solution”? Often, in asking both questions I get a nuance in their answer that will get me even closer to resolution. Typically, the daughter will begin to talk, not about herself, but about what is important to her mother. Your question is about the impact on the daughter, the resister, not the mother. When she finishes talking about her mother, refocus or reword the question back onto the impact on her. You cannot know the daughter’s need if you do not know the impact on her.
Once I think I have someone’s need I will try to get a clearer picture of their future. With the need will come multiple options. Sifting through several options will also create clarity for both the need explorer and the person in the conflict.
Qt #1: What do you want?
- Doctor: “You seem resistant to my proposed treatment plan. Can you tell me what action you would prefer to take regarding treatment?”
- Daughter: “Your plan will take too long. It requires numerous trips back and forth to your office.”
Qt #2: Why do you want this?
- Doctor: “Why is a short treatment plan better for you?
- Daughter: “I cannot take the time out of work to get mother back and forth to your office for all of those visits you want her to have.”
Qt #3: What impact will it have if...?
- Doctor: “What impact will it have if you had to endure a longer treatment plan?”
- Daughter: “I would lose my job taking off that much time from work.”
Qt #4: “If we could find a way to get your mother back and forth without you having to take time off from work, would my treatment plan proposal work for you?”
Or: “If we could find a way to shorten the number of visits here at the office, would my treatment plan proposal work for you?”
You have no idea what is stalling the daughter’s decision making process, why she is resisting your proposal. It could be she cannot afford the treatment. It could be that she is the primary care giver for mother and her siblings will not help with transportation, time, or finances. It could be that her husband is angry about how much time mother’s care is taking away from the marriage and the family. The only way to know, and address it effectively is to explore her resistance. Only a doctor with good exploration skills will find the pinch point and create a path around it to a comfortable resolution.
A resolution needs to do at least three things: it must address the fear of loss, it must create comfortable decisions, and it must provide for the person’s needs. When the gain outweighs the fear of loss and the identified needs are clear enough to understand their overall value, then resolution resistance will dissolve into agreement. A person will always choose a gain within their comfort zone, within their understanding. If the doctor fails to explore options enough for the daughter to understand the personal gains within the proposed solution, then she will never be comfortable choosing the doctor’s proposed treatment plan.
Work on your question asking skills and get started as a resolution resistance explorer. Poor resolution exploration skills can cost your practice financially and emotionally. Indecision wastes time and money.
We all have basic human needs, much like Maslow states in his hierarchy of needs. Those situations that drive us into a conflict reflect some kind of threat to our basic needs. Listen for these things when you explore.
Practice on yourself. After all, you are human; you have basic needs. When you find yourself in a decision making situation practice looking deep within yourself and asking what it is you want. Why do you want this? How will it help you? What will it do for you? And follow up with: What will be the impact on your life if you do not get what you are asking for or demanding? As you get better applying this skill to yourself, you will improve as a resolver of conflicts. With improvement you will find the difficult situations in your practice becoming less and less of a challenge as you find yourself becoming more and more successful in helping your patients make decisions in their best interest and ultimately the best interest of you and your practice.
Satisfaction with the ability to communicate clearly and comfortably with a physician is a top reason for repeat business and referrals.
Richard Voyles, Ph.D. is the President of Conflict Resolution Academy, LLC a service company providing professional and personal development skills. Conflict Resolution Academy, LLC offers conflict prevention programs through Management and Leadership Training and resolution programs through Mediation Training and Mediation Services. Conflict Resolution Academy, LLC has developed 17 videos that focus on the mediation process steps, mediation techniques, legal and ethical issues, and a mediation roleplay. These training presentations specialize in facilitative mediation skills at every level. Dr. Voyles is a subject matter expert in the areas of Conflict Management and Dispute Resolution. He is a registered Neutral with the State of Georgia's Office of Dispute Resolution, and he has traveled the world, training people in conflict management and mediation skills. Dr. Voyles does extensive work in the areas of prejudice reduction, cross-cultural communication and conflict management. He is currently recognized internationally in Who's Who in 2002 in Business. Dr. Voyles can be contacted at firstname.lastname@example.org.
by Richard Voyles, Ph.D.