Chapter 1: Interpersonal challenges

"Relationship Management"

There may be times when you find yourself working with a patient or family member who is particularly challenging. They may seem confrontational or non-compliant; unpredictable or inflexible; flattering or dismissive; charismatic or obnoxious. They may create a sense of chaos within the family – and on your team. This can lead to disagreements among family members and members of a health care team about the care plan as people begin to side either with or against the person.

In such situations, it’s important for you to pay attention to your own feelings and reactions. You may simply feel that something is “off”. You may feel frustrated, angry, or confused – or “at the end of my rope”. If you notice that you or a colleague is responding to the person in ways that are not usual for you, take time to reflect on this. It's a strong indication that you need to make changes in the way you interact with the person.

“Relationship Management” is an approach that you may find useful in situations where you’ve exhausted your regular strategies. It requires you to step out of your comfort zone and use strategies that may not feel familiar or comfortable. This approach can help you to interact in ways that are respectful, compassionate, and professional, and that result in better outcomes for patients, families and you.

See also:Relationship Management—When Encounters With Patients Challenge us   

Things to look for

In yourself or a colleague:

  • Difficulty maintaining boundaries (e.g., wanting to shorten or lengthen a call; disclosing too much personal information).
  • Alternating between feeling sympathy and irritation.
  • Ruminating excessively about a call.
  • Dreading the next call.
  • Generally becoming more emotionally involved (positively or negatively) than usual.

 In a patient or family member:

  • Unpredictable and “big” emotional outbursts.
  • Non-compliance with care plan.
  • Failure to link actions and consequence.
  • Attempts to control or manipulate a situation.
  • Excessive or unreasonable demands.

Changing your approach

If you want different results, you have to try something different. Here are some strategies you might try:

  • Remember that while you can’t change the other person, you can change your response to them.
  • Consider that the person may be doing their best under difficult circumstances.
  • Treat them with respect and compassion.
  • Refrain from giving advice (even when asked) or arguing. Instead, present options.
  • Respect and affirm their right to make decisions that you may not agree with.
  • Debrief with your partner or a trusted colleague after a difficult call.
  • Review your strategies before every call.