Table 1

Framework for managing conflicts in medical situations

Area or attributeExamplesOld wayNew way
Paternalism consentStudent asked to get consent from a patient for a surgical procedure the student has never heard of beforeAccept task, do not let senior staff know level of ignorance about procedure, talk to the patient about the procedure in a vague and superficial way so as to get the patient's signature on the consent formDecline the task and suggest that a doctor with some familiarity with the procedure would be more appropriate for this task.
Accept the task, but explain you know little about the procedure so will need some teaching about it first and request that one of the doctors comes along to help/supervise.
Infallibility of doctors; attitude to mistakesMistakes are only made by people who are incompetent or unethical. Good doctors do not make mistakes.Accept the culture that says doctors who make mistakes are ‘bad’ or ‘incompetent.’ Try harder to avoid making a mistake. Remain silent, or find someone or something else to blame when you have made a mistake.
Look at the mistakes others make and tell yourself you wouldn't be that stupid.
Understand that everyone will make mistakes at some time and that the causes of errors are multifactorial involving latent factors not immediately obvious at the time the error was made. Look after your patients, yourself and your colleagues in the event of an error and actively promote learning from error.