About the Author
master’s degree in
and medical degree
He is currently a
at the University of
Paul Charlton, M.D.
Accessing the Hidden Curriculum:
Conflict Management Training
in Health Professions Education
I wish such incidents were a rarity, but they
are not. In my work life as a resident physician,
I see conflicts unfold every day—negotiations
with verbally abusive patients in the Emergency
Department, physicians on different teams
exasperated with one another over patient care
decisions, nurses and physicians tip-toeing
around each other because of tense relationships.
And it’s no surprise. U.S. health care involves
over 800,000 physicians, millions of nurses,
with trillions of dollars on the table. Lives are lit-
erally on the line. This is a complex, high-stress,
high-stakes industry. Conflict is simply a part of
life in health care.
So why is it that when I tell most of my colleagues
that I did a masters degree in conflict resolution
before going to medical school, they ask me, “What
does that have to do with medicine?”
Why is it that other professional training pro-
grams in law and business have embraced
training in negotiation and conflict management
as central aspects of their fields, while negotia-
tion and conflict management are nowhere to be
seen in medical or nursing education? Why do
Mary, the new patient in bed nine, wore a pained smile. She was in her
mid-50s and she had come in alone to the emergency department where
I was rotating as a medical student. Her complaint was abdominal pain.
In her hands she held a stack of medical records showing that she had
metastatic ovarian cancer that had spread throughout her abdomen.
The cancer had been unresponsive to surgery or chemotherapy. She was
likely to die from this in the coming months.
We performed several basic tests for Mary in the ED, which showed that medically
there was little we could address for her that day. Her pain was controlled and we
placed a referral for her to the oncology clinic. When we asked if there was anything
else we could do, Mary said no and left.
Two hours later, the patient liaison officer for the hospital came to the ED. “Excuse me,
Doctor, the sister of one of the patients you treated this afternoon would like to speak
with you. And to forewarn you, she is really angry.”
I joined the head physician in a family conference room with Mary’s sister.
The sister was livid. “How could you discharge my sister? I drove her here from 5 hours
away. What kind of physician are you, what kind of person are you, to send her home
From there it went downhill. The physician tried to explain, the sister grew angrier,
the physician got defensive, round and round, until finally the sister demanded that the
chair of the department be called in from home to deal with the situation.
When all was said and done, this encounter occupied over 90 minutes of the
physician’s day, during which time the care for the physician’s other 15 patients in the
emergency department ground to a halt, causing a cascade of discontentment in the
department. The physician left that day feeling overwhelmed, frustrated and burnt out.