Health professionals identify difficult interactions as one of their most pressing challenges. Cognitive Institute Medical Director Dr Mark O’Brien outlines key strategies for how to deal with these situations

Disruptive doctor behaviour is a significant barrier to effective communication. Rosentstein (2002) surveyed 2500 hospital staff and found:

  • that 90% had witnessed disruptive physician behaviour
  • one third of respondents knew of colleagues leaving an institution as a result of a colleague’s behaviour
  • there were significant barriers to reporting disruptive behaviour. (1)

It is ironic that often people who work outside the traditional professions receive more training in handling difficult and complex interactions than many professionals. The lack of clear understanding of what makes interactions difficult and how to effectively handle them contributes significantly to professional dissatisfaction over time.

When analysing the factors that contribute to making interactions difficult it is interesting to consider that many of the challenging behaviours identified by professionals can bear a strong resemblance to normal adolescent behaviour.  

A key challenge one faces in adolescence is taking on responsibility for one’s own actions and learning to make decisions when faced with challenges. In childhood, social norms dictate that responsibility for a child’s behaviour and significant decisions that impact on the individual’s welfare is taken on by the child’s parents. By adulthood we have an expectation that adults will take responsibility for their own actions and will problem solve when faced with difficult situations.  

It is interesting to consider that a small percentage of the population may struggle in their adult life to actually make the transition to full acceptance of responsibility for their actions and the ability to make decisions. These two attributes are probably the most important skills that we need to acquire as we transition through adolescence. 

In the ‘difficult person’, a professional may see someone who often fails to problem solve and seems more interested in justifying their current position than actually trying to bring about resolution. They may also identify a willingness to blame others for their misfortune or challenges rather than accepting that luck and fate plays a significant role in all our lives.

In successfully dealing with difficult situations, four key skills have been identified:

1.    Stating that there is actually a problem in the relationship or the interaction. 
Observers of difficult interactions have often noted that people are reluctant to raise, at any stage during an interaction, that a problem exists in the way the relationship is going. Stating there is a problem allows the possibility that the issue can be discussed and addressed in a way that can reset the entire interaction.  

2.    The ability to set firm boundaries around the conduct of the relationship. 
This is an essential element of managing difficult interactions, particularly if the person is struggling to maintain the normal boundaries that are seen in adult behaviour. In challenging or difficult situations, people who are struggling to maintain a focus on problem solving and decision making can be helped enormously by clear statements about the parameters under which decision making can occur.  

3.    The ability to show genuine care towards a person in a difficult situation, regardless of how challenging their behaviour is.
Models of change consistently show that without a strong feeling of support and a belief that their concerns and issues are understood, progress to resolve difficult situations is almost impossible. Portraying your actions at all times as being in the other person’s best interest is extremely effective.

4.    The ability to focus on achieving an appropriate outcome.
Rather than arguing about who is right or who is wrong, focusing on achieving an outcome in a difficult situation is seen by many as the hallmark of the emotional intelligence of the high performing professional.


  1. Rosenstein AH, Original research: nurse–physician relationships: impact on nurse satisfaction and retention, Am J Nurs 102(6):26-34 (2002)

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