Why doctors fight

One of the biggest challenges in getting physicians to work together cooperatively is the fact that they have never been trained to do so.

One of the biggest challenges in getting physicians to work together cooperatively is the fact that they have never been trained to do so, noted Wendy Lipton-Dibner at a session on physician relations at the Medical Group Management Association's annual meeting in New Orleans this October.

“Physicians are trained to be independent, not group players,” said Ms. Lipton-Dibner, president and founder of consulting firm Professional Impact, Inc. “And they are accustomed to thinking of themselves as special.”

Discord can not only be disruptive, it can cost an individual doctor, practice and/or hospital money, because doctors who can't work together aren't inclined to share useful advice that can improve care and finances. To help eliminate conflict, it is instructive to first examine its causes, she said.

Psychosocial causes

A lot of conflict boils down to personality differences, said Ms. Lipton-Dibner, a trained psychologist. For example, there is often tension between physicians who are indirect vs. direct when it comes to taking action. Indirect doctors are soft-spoken and slow-paced, have closed and subtle behaviors and facial expressions, and use minimal hand gestures. Direct physicians are open and dramatic, louder-spoken and faster-paced.

“The differences between these two types alone can cause problems,” Ms. Lipton-Dibner said. “But on top of it, you have whether these two types are people-oriented or task-oriented.”

People-oriented doctors use lots of eye contact and touching, and stand less than three feet from a person when talking. “This is uncomfortable for patients or other physicians who aren't used to it,” she said. Task-oriented doctors are focused on objects, stand more than three feet away, and never touch. If the latter type of person recoils from the former, the former thinks, “Oh, that person doesn't like me,” Ms. Lipton-Dibner said, and that can cause problems.

People-oriented, indirect doctors are the “relaters” of the group, she said. They are absolutely conflict-averse. They stay too long with patients and chronically run behind schedule, so their productivity is low…but patients adore them. Meanwhile, people-oriented, direct doctors are the “enthusiasts.” They are always talking; they are loud, fun and keep everyone laughing. They loathe paperwork.

Task-oriented, indirect physicians are deemed “thinkers.” “These are the ones who are likely to say, ‘Well, we will need to look at the data and make a decision in six months,” Ms. Lipton-Dibner said. “You want to mess with a thinker? Throw them a surprise party. Surprises and people are the two things that rattle them.”

The “commanders” are task-oriented, direct doctors, the type often seen barking orders into a cell phone. They focus on the bottom line and tend to make the most money of the four types; they hate meetings because they feel they already know the answers to everything. “The commanders look like they have no heart, but they are just misunderstood,” Ms. Lipton-Dibner said.

People-oriented and task-oriented physicians tend to rub one another the wrong way; enthusiasts and thinkers, in particular, often clash, she said. All types need to realize the others contribute something valuable to the team, however.

“Teach the [other] physicians about these four different types, and 50% of your relational problems will be gone, because they will understand there's a reason for the clashes,” she said. “They also may realize they need to modify their behavior with different types—an enthusiast needs to tone it back with a thinker, for example.”