Conflict Resolution in the Operating Room

November 5, 2019

Patient care is dependent on effective teamwork between the anesthesiologist and the surgeon.Conflict between the two detracts from this shared goal and endangers the patient.1 It also uses up valuable time. In a recent study, it was reported that physicians spend 20% of their executive time resolving conflicts.2 Moreover, conflict can lead to sleep deprivation, which can in turn perpetuate issues of conflict resolution.3,4 Despite this, a survey of anesthesiologists found that 77% considered their relationship with surgeons to be troubled.Lower levels of conflict would benefit both parties, both professionally as well as personally, by leading to higher quality patient outcomes and to lower rates of professional burnout.5

In order to lower conflict, it is important to first understand its causes. One of the main contributors to conflict is a lack of respect and understanding. Advancements in the field have elevated anesthesiology to a position equal to that of surgery.Previously, the role was more to assist the surgeon and not an independent specialty.However, it is still seen as a behind-the-scenes role.1 Even among medical professionals, there is a lack of understanding. In a study conducted to assess the knowledge of paramedical staff, 35.85% considered anesthesiologists to be assistants. Only 49.2% of staff knew that anesthesiology was its own specialty.6 Patients are similarly not as informed, which results in them attributing their well-being and safety to their surgeon.7 There is also a general feeling that anesthesiologists are paid less despite the time commitment.This low level of recognition and compensation leads to frustration. It can be combated by raising awareness publicly about the role of anesthesiologists.1

Conflict between anesthesiologists and surgeons may also arise due to differences in information, opinion, values, experience, and interests.8 Additionally, they may disagree on ethical matters when it comes to treatment plans, informed consent, and directives, such as DNRs.9,10 In a high pressure OR where both parties are highly-trained and highly-educated, a simple difference in thinking may lead to a dispute.11 Similarly, different personality traits, such as perfectionism or aggressiveness, may make it difficult for either party to acknowledge the other’s experience or skill.12 Moreover, the hierarchy among the medical team is blurred given the complexities of the OR, so there is no clear final authority.13 This can be prevented by setting ground rules and adhering to conduct guidelines.1,14

The inequality and lack of reciprocal trust between surgeons and anesthesiologists leads to breakdowns in decision-making and communication. These breaks increase the likelihood of preventable medical errors, which can in turn lead to legal complications or loss of resources.1,15,16 Both parties need to remember that each has the patient’s best interest in mind and that they have a common goal of quality care. Acknowledging this may help surgeons and anesthesiologists maintain respectful, professional relationships.1,2

There must also be systems in place within hospitals designed to reduce conflict, including crisis resource management training and interdisciplinary team training programs.17,18 There should also be adequate facilities. A lack of preoperative clinics, specifically anesthesia clinics, can result in an increase in cancellations due to ill-prepared or ill-assessed patients. This can create frustrating environment to work in.1

In addition to established policy and procedure, conflict resolution requires a level of emotional maturity, self-control, and empathy on the part of the anesthesiologist as well as the surgeon.1 Both must anticipate conflict and always be prepared to resolve any issues that arise in a professional manner.

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