It's Not About Winning or Losing: How Consultants Navigate Disagreement in Serious Illness

Area of Science:

• Medical Education
• Clinical Communication
• Healthcare Disparities

Background:

• Disagreements between consulting and primary clinicians are frequent in serious illness care.
• Clinicians find these disagreements distressing, yet optimal preparation strategies remain unclear.

Purpose of the Study:

• To explore consulting physicians' (fellows and attendings) experiences with disagreement.
• To identify skills that could improve physicians' navigation of inter-physician disagreements.

Main Methods:

• Semi-structured interviews were conducted with fellows and attending physicians in palliative care, nephrology, and gastroenterology.
• Inductive thematic analysis was used by two independent investigators to analyze interview data.

Main Results:

• Disagreements perceived as negative were often interpreted as challenges to expertise or identity, particularly by trainees.
• Attending physicians prioritized relationship-building communication alongside decision-making, unlike fellows.
• Physicians found direct communication and acknowledging the other party's perspective productive.
• Little formal training in disagreement navigation was reported; skills were primarily acquired through experience.

Conclusions:

• Fellows in consulting specialties feel unprepared to manage disagreements with primary clinicians.
• Attending physicians possess experiential skills in communication, relationship building, and perspective-taking that could be formally taught to fellows.