Conflict, complaints and difficult clinical encounters — formative SAQs

SAQ 1 (10 marks)

A father is shouting on the ward because his 6-year-old daughter's scan result, promised yesterday, has not arrived. He is distressed but has no weapon and is not violent. [5] [3]

1. Describe your immediate assessment and first steps in the encounter. (3) [5]
2. Outline the structured verbal de-escalation approach you would use, naming its key moves. (4) [5]
3. Describe how you would close the encounter and what you would arrange afterwards. (3) [3]

Model answer

Assess safety first: confirm there is no weapon, threat or intoxication, and keep an exit available. Move to a private space with the right people, and ask openly what has happened and what he most needs today. Review the timeline and facts of the result delay and identify any genuine service failure honestly. [5]

Use structured verbal de-escalation drawn from the Project BETA consensus: respect personal space and keep an exit; do not be provocative in posture or tone; establish verbal contact with brief, plain language; identify wants and feelings; listen closely; agree, or agree to disagree, rather than argue; set clear, reasonable limits; and offer choices and optimism. [5]

Close by acknowledging the emotion, agreeing a clear plan (the result, a timeframe, a contact), and arranging follow-up. Document factually and contemporaneously, and arrange a team debrief; if a shortcoming occurred, apologise sincerely and feed the learning back. [3]

SAQ 2 (10 marks)

In the PICU, parents of a child with severe hypoxic brain injury insist on continued full life-sustaining treatment the team judges non-beneficial. Later they lodge a formal complaint, and the registrar involved becomes withdrawn and is practising defensively. [6] [9]

1. What is the most likely underlying driver of the parents' demand, and outline your stepwise management of the dispute. (4) [6]
2. Outline how you would respond to the formal complaint, including the role of a sincere apology. (3) [1] [2]
3. Explain the second-victim concept and describe the support you would arrange for the registrar. (3) [9]

Model answer

The likely driver is unmet hope and inadequate prior prognostic communication, not parental unreasonableness. Manage stepwise: re-explore the family's values and what they most want, re-share prognosis honestly, seek a shared decision and a second opinion, and call a formal ethics consultation or mediation early; a randomised trial showed ethics consultation reduces non-beneficial treatment and conflict. [6]

Respond to the complaint within the local timeframe: acknowledge promptly, listen, apologise sincerely for any genuine shortcoming (protected from use as an admission of liability in many jurisdictions), investigate the facts, respond in writing with a timeline and what will change, and feed the learning back to the family and the system. Complaints predict malpractice risk and are a safety dataset. [1] [2]

The second-victim concept describes the clinician's recognised recovery trajectory after an adverse event or complaint: shock, intrusive reflections, then supported recovery or, if unsupported, anxiety, depression, defensive practice and attrition. Arrange a debrief, peer and practitioner-health (employee-assistance) support, timely information about the process, and address the systemic contributors so one event supports rather than loses the clinician. [9]