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How do you resolve disagreements with physicians over patient care?

As a nurse, you may encounter situations where you disagree with a physician over the best course of action for a patient. This can be challenging, especially if the physician is senior, authoritative, or dismissive of your concerns. However, resolving disagreements constructively is essential for patient safety, quality of care, and professional collaboration. Here are some tips on how to approach and handle these situations.

1 Identify the source of disagreement

Before you engage in a discussion with a physician, try to understand why you disagree and what your goals are. Is it a matter of clinical judgment, evidence, ethics, preferences, or communication? Are you advocating for the patient's rights, needs, or wishes? Are you following the nursing standards of practice and code of ethics? Clarifying these points can help you prepare your arguments and avoid personal attacks or emotional reactions.

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Demetrius Kirk, DNPc, MBA,MSN, RN, LNHA, LSSGB, PAC-NE, QCP

Elite Healthcare Turnaround Executive | Healthcare Systems Transformation Expert | CMS Regulatory Expert | Operational Excellence Strategist | Executive Leadership Coach
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What's causing the disagreement? You have to be able to understand their perspective. This does not mean that are right and you are wrong. Look for evidence to prove or disprove your thoughts.

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Adv. Rabin Majumder Supreme Court of India

Disputes Resolution. Medical Negligence / Healthcare, Consumer, PMLA, Matrimonial, Commercial, Environment, Property, WILLS, & Succession cases.
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In India, medico-legal scenario is largely regulated by medical protocol governed by National Medical Commission, laws framed by Govt. of India and Medical Councils of respective States, apart from being so self-regulated. Supreme Court of India has in catena of judgments held that the essential ingredients to determine medical negligence are: 1. Duty of care extended to the complainant. 2. Breach of that duty of care. 3. Resulting damage, injury or harm caused to the Victim is attributable to the said breach of duty. The protocol includes Informed Consent, not a mere discussion with the Patient/patient party. Ref. Samira Kohli vs Dr. Prabha Manchanda etc. Discussion with Patient a must in Indian medical protocol.

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2 Choose the right time and place

Timing and location are important factors for having a productive conversation. Avoid confronting a physician in front of patients, families, or other staff, as this can create tension, embarrassment, or defensiveness. Instead, find a private and quiet place where you can talk without interruptions or distractions. Also, consider the urgency and severity of the situation. If the patient's condition is critical or unstable, you may need to act quickly and assertively. If the situation is less urgent, you may have more time to gather information and consult others.

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Demetrius Kirk, DNPc, MBA,MSN, RN, LNHA, LSSGB, PAC-NE, QCP

Elite Healthcare Turnaround Executive | Healthcare Systems Transformation Expert | CMS Regulatory Expert | Operational Excellence Strategist | Executive Leadership Coach
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The time to disagree with a provider is not in front of a patient. Anytime I disagree with a provider, I pull them aside and tell them how I feel. Now if its going to impact patient care or harm the patient I will speak up at the right time.

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3 Use respectful and clear communication

When you talk to a physician, use respectful and professional language and tone. Avoid accusatory, sarcastic, or aggressive words or gestures. Start by acknowledging the physician's expertise and perspective, and express your intention to collaborate and find a mutually agreeable solution. Then, state your concerns and reasons clearly and concisely, using facts, evidence, and examples. Avoid generalizations, assumptions, or opinions. Listen actively and attentively to the physician's response, and ask open-ended questions to clarify or explore their point of view. Try to find common ground and areas of agreement, and avoid getting sidetracked by irrelevant or personal issues.

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Demetrius Kirk, DNPc, MBA,MSN, RN, LNHA, LSSGB, PAC-NE, QCP

Elite Healthcare Turnaround Executive | Healthcare Systems Transformation Expert | CMS Regulatory Expert | Operational Excellence Strategist | Executive Leadership Coach
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No matter who you are talking to, you should always be respectful. Do not try to undermine or scream at no one. Be respectful and clear during your communication.

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4 Seek support and feedback

If you are unable to resolve a disagreement with a physician on your own, you may need to seek support and feedback from others. Depending on the situation, you may consult your colleagues, supervisor, manager, or ethics committee for advice, guidance, or mediation. You may also document the disagreement and your actions in the patient's record, and report any incidents or errors that may have occurred. Seeking support and feedback can help you protect your patient's interests, uphold your professional standards, and learn from the experience.

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Anna (Ania) Schwarzbach

Empowering community practices/oncologists to offer more clinical trials access to a diverse range of patients they serve
(edited)
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I recommend prioritizing this step in position 1 or 2. Seeking diverse perspectives before engaging with a physician, especially on a controversial topic, is likely to yield a more comprehensive understanding of the topic and the underlying reasons for any disagreements. This approach will enable providing a better-informed and more constructive solution.

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5 Reflect and learn

After you resolve a disagreement with a physician, take some time to reflect and learn from the situation. Ask yourself what went well and what could have been done differently. How did you handle the conflict? How did you communicate your concerns and listen to the physician's response? How did you reach a resolution? What did you learn from the physician's perspective? How did the disagreement affect your relationship with the physician and your team? How can you prevent or minimize similar disagreements in the future? Reflecting and learning can help you improve your skills, confidence, and satisfaction as a nurse.

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6 Here’s what else to consider

This is a space to share examples, stories, or insights that don’t fit into any of the previous sections. What else would you like to add?

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How do you resolve disagreements with physicians over patient care?

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1 Identify the source of disagreement

2 Choose the right time and place

3 Use respectful and clear communication

4 Seek support and feedback

5 Reflect and learn

6 Here’s what else to consider

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