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Adversity is common in everyday life and has the potential to bring stress to any situation, even in an aesthetics practice environment. For instance, a patient complaining about a lack of parking, an unintentional wait time, or even the weather can disrupt an otherwise pleasant office atmosphere.

Regardless of the conflict or the level of stress it produces, the reality is that sometimes things just aren’t “great.” To best cope with patient-based adversity, practice team members should utilize these six tips the moment tensions arise, before diving in to define a solution:

• Remain calm
• Keep it private
• Apologize
• Designate a lead and a witness
• Listen, repeat, and record
• Don’t rush

Remain Calm

By remaining calm, it is possible to gain control of the situation. This can be a challenge, though, because it is difficult to remain calm when someone is angry, agitated, unkind, demanding, tearful, volatile, unrealistic, or highly emotional. Unexpected conflict can be startling, causing one to freeze up; or, conversely, it could evoke agitation. Either reaction allows for fight-or-flight mechanisms to take control. Responding to high emotions with equally high emotion will only escalate the stress and create a pattern of conflict with no way out.

Recommended calming techniques include breathing slowly and deeply and decelerating the pace of all actions (e.g., speaking, walking, typing). Even in the most emergent situations, 911 operators tell callers, “Stay calm, speak slowly.” There is a reason for this: By slowing down, individuals can better process what is transpiring, think through their responses, and take control of the tone and the pace of the situation. As a calm atmosphere is restored, the agitated person will begin focusing on the composed team member rather than the stressor.

Keep it Private

Keeping the situation private ensures confidentiality, contains the conflict, and preserves the involved team member’s relationships with others. Conflict becomes uglier when it happens in the presence of unrelated parties. Bystanders watch, wonder, and question. Despite their noninvolvement, sometimes they are deeply affected by the encounter. This can impact their relationship with the team member involved in the conflict. Keep conflict private by moving the situation and the individual(s) involved to an isolated location. For example, consider responding to a vocal patient in the reception area by calmly stating, “Let’s please move our conversation down the hall to the consultation room.” No excuses or explanations are necessary; a kind directive is all it takes.

Practices should designate, in advance, an optimal private space to use when adverse encounters occur. Additionally, an alternative space should be designated for times when the primary space is unavailable. Don’t wait to free the designated space if it is currently occupied; instead, move the situation to another private space away from public areas or proximity to other patients. The designated area must be accessible to other team members whose involvement may be necessary. Additionally, if the team member managing the conflict does not have a wireless phone or headset, the encounter should be moved to a room with an intercom or telephone for the purpose of maintaining contact with the team.


Offering an apology does not mean accepting responsibility or admitting fault. “I’m sorry you are feeling this way,” is a simple acknowledgement of human emotion. The statement demonstrates respect and compassion for another person’s situation and feelings. It also provides an opportunity to establish leadership and gain control of the situation. While expressing positive intent is difficult when dealing with difficult people or circumstances, doing so provides a significant advantage to the team member mitigating the situation.

Designate a Lead and a Witness

Designating a leader and a witness is essential to fact-finding. Additionally, it further assures the individual creating the chaos that someone is responding to him or her. Ultimately, this is what the person desires. At the moment conflict arises, a leader and a witness should be designated. These two individuals should be present throughout the entire encounter. Each role is discussed below:

Leader. A leader must apply all the key coping tips discussed previously (i.e., remaining calm, keeping matters private, and apologizing). This is the person best suited to assess the conflict, not necessarily the one to best resolve it. For example, in the case of an adverse outcome, the physician may not be immediately available; however, an available nurse or other support staff may be capable of initially assessing the situation.

Witness. The witness is present to watch, listen, and document conversations, actions, and observations. A witness must not engage or react and is equally responsible for remaining calm and composed. Importantly, the leader needs to introduce the witness and his or her purpose: “This is Ashley; I’ve asked her to take notes for me as I would like my focus to be directly on you.” This simple statement credentials why the other person is present and further affirms that the leader is in control of the individual and interested in resolving the conflict.

Listen, Repeat, Record

It is essential to listen, repeat, and record from the time the conflict begins through its resolution. These actions help in accurately recording the facts and examining conditions. They also make it easier to organize the information when defining the solution. Listen and repeat is not listen and agree, nor is it listen and refute. “I understand that you are upset about the current wait time in the office,” is not the same as, “I’m sorry you have to wait, but you were 40 minutes late for your scheduled appointment and you got bumped.” The latter may be true, and the team member may have every right to say so; but expressing this will only provoke and aggravate someone who likely is already unreasonable.

Don’t Rush

While the ultimate goal is conflict resolution and the ability to move forward, there is a tendency to rush to wrap up things once everyone is calm. A rushed solution, though, invites conflict back into the situation because it can lead to misunderstanding, mistakes, second thoughts, and even a sense of being dismissed. Keep in mind the six key strategies and keep the pace steady and slow. Take a few moments to step back and enlist any individuals or resources needed to formulate and agree upon a solution. Repeat and review the facts together with management and providers, gain consensus or approval on the solution, and determine how and what to present to the patient. For example, irate, chronically late patients don’t need to know that the protocol for the practice is to red-flag their chronic behavior and document their demands in the chart. What should be presented to these patients are apologies, an opportunity to wait for the provider, an estimate of how long the wait will be, and the option to reschedule.

Conversely, a patient experiencing an adverse event needs to be reassured that the team member is focused on addressing the situation and is capable of carrying out the directions of the provider with whom the details have been shared.


These tips aren’t exclusive to dealing with patient conflict. They are equally helpful for managing internal practice issues, particularly those that challenge practice leadership and interfere with the team ethos. An example is a situation in which a coworker or employee is engaged in excessive negativity and “drama.” Utilize the tips discussed in this article to ensure a happy staff, as well.

Happier Patients

Coping with conflict is an unfortunate reality and is often driven by uncontrollable circumstances. What team members can control, though, is how they react to conflict. By engaging in logical and consistent techniques, it is possible to become better at recognizing, containing, and resolving conflict so that patients are genuinely happier. n

Marie Czenko is a management consultant with the Allergan Practice Consulting Group of Allergan, Inc., a specialty pharmaceutical company based in Irvine, California.

Ms. Czenko consults with dermatology and plastic surgery practices in the areas of financial analysis, practice valuations, human resource issues, internal and external marketing, leadership training and team building, sales training, compensation, and cosmetic practice development.

Ms. Czenko has more than 20 years of consulting and training experience. Prior to joining the Allergan Practice Consulting Group, Ms. Czenko was an independent practice management and transition consultant. Before that, she worked as a public education specialist with the American Society of Plastic Surgeons. Ms. Czenko is a frequent speaker at various professional conferences and symposia, as well as an author of practice management articles and guides in dermatology, plastic surgery, and ophthalmology. She earned her Bachelor of Business Administration in marketing from Loyola University, Chicago and a Master of Arts in communications from The Ohio State University.

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