I am currently employed within a Veteran’s Administration primary care setting, and I have seen instances in which communication was effective in de-escalating a conflict and instances in which the communication style of the provider likely resulted in conflict escalation. When I consider this incident in which escalation occurred within the context of the information learned in the course, I realize that the provider could have done a number of things to change the outcome of the situation.
There has been a recent initiative within the Veteran’s Health Administration to reduce the prescribing of opiate pain medication (U.S. Department of Veterans Affairs, 2016) as its use has become exceeding prevalent and often-times problematic. From July of 2012 to June of 2015, there was a reduction in the number of veterans receiving opiates. Namely the numbers decreased by 115,5757 nationwide. This drastic reduction affected multiple Veterans Affairs hospitals, and I witnessed a direct confrontation over this manner.

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I was working within the hospital, and I saw a patient who was speaking with his primary care physician about his chronic back pain and options for treatment. He had tried a TENS unit, physical therapy, and opioid pain medications. He reported that the opioid pain medication was the only thing to take some of the edge off of his pain so that he could sleep at night. He reported significant pain, and options were discussed with him. The only option that was left was having back surgery in order to attempt to attenuate the pain problem. The patient was not receptive to having such a potentially complicated medical procedure done; he wanted an increase in his pain medication. A chart review revealed that he had self-referred for an opiate addiction treatment program when he was in the military and he was receiving medication following a serious injury. As such, his providers had been especially careful in prescribing him the medication. His chart also revealed that he was reporting suicidal ideation. As such, the prescribing physician decided that he no longer wanted to prescribe the opiate pain medication. He stated to the veteran that he wanted him to consider the surgery and that he was not able to prescribe him any more pain medication. The patient asked why this was the case as the medication was the only thing providing him with relief. The provider did not directly answer this question, and the veteran began to get angry. The provider continued to document on his computer and the veteran began pleading for pain medication as it was the only thing that allowed him to sleep. The provider largely ignored the veteran’s request and before leaving the room stated that he would place a consult for the pain clinic, but aside from surgery, there were not many other options. The veteran became angrier and stated that he would be going to an outside provider in the future.

If the principles discussed in the text were used in this situation, things may have played out different. In particular, active listening (e.g. Brower & Darrington, 2012; Kopecky, 2015) could have helped the veteran feel heard. If the provider stated, “I understand that you are upset and feeling like there are no alternatives, and we can set you up with the pain clinic to see if there are options that I am unaware of” the veteran may have responded differently. Moreover, if the provider noted his own body language (e.g. typing at the computer) he would have stopped what he was doing to address the veteran’s concerns directly. Finally, had the provider noted the inherent power dynamics, and the fact that he was enacting more power by taking away the veteran’s only source of pain relief, he may have done this in a more caring manner.

  • Brower, N. & Darrington, J. (2012). Effective conflict resolution. Retrieved from: http://extension.usu.edu/files/publications/publication/FC_Relationships_2012-02pr.pdf
  • Kopecky, H. (2015). Communication and conflict resolution. Retrieved from: https://www.rochester.edu/ucc/help/info/comconflict.html
  • U.S. Department of Veterans Affairs. (2016). By the numbers: VA making progress in reducing opiate use in veteran patients. Retrieved from: http://www.blogs.va.gov/VAntage/21796/va-making-progress-reducing-opioid-use-veteran-patients/