Responding to the emerging conflicts that divide us

Commentary. By Leonard J. Marcus, PhD, and Barry C. Dorn, MD, amednews contributors. Dec. 17, 2001.

COMMENTARY

Observations on the state of medical practice and medical life

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The initial moment of crisis is over. Fading now are the searing images of Sept. 11, the immediate grief and the raw emotions that overwhelmed us. Fading, too, are those first reassuring portraits of our coming together. In recent weeks, the front pages and headlines have conveyed a new sense of conflict and turmoil on the home front. We cope now with "what's next?"

There are numerous examples. New York firefighters and policeman scuffling at ground zero. Ethnic and religious leaders arguing about "taking sides." Health care managers pointing to insufficient "preparedness" resources. And the electorate, which at various times has become impatient with public officials accused of releasing either too little or too much information about public health threats.

The aftermath of the initial anthrax letters and the fear of smallpox have put the health system straight into the middle of this international conflict. While it is certainly not in our purview to resolve larger global disputes, we very well can play a role in managing the issues and disputes that we find in our midst.

The problem of blame

It is human nature to seek a guilty party when a catastrophe occurs. We want to point a finger, punish the perpetrator and, with that, assure ourselves that the crime will not be replicated. There is a calming effect in capturing those responsible, bringing them to justice and resuming a semblance of normal activity.

This rather straightforward instinctual response has been complicated by the events of Sept. 11 and subsequent bioterrorism. Early on, we focused squarely on one man. But Osama bin Laden is an elusive and baffling menace: He and his al Qaeda network are not a tangible place, a recognized country or a typical antagonist. In this conflict, the front lines are not an ocean away. The front-line danger has been as close as our own work place mailroom, and, with that, we have begun to blame one another.

It would be easy to vent outrage among ourselves. Sprouting about us are the ingredients to ferment significant conflict within and between communities and within our health care organizations. We have conflicts with colleagues who have Middle Eastern roots, with public officials groping to make difficult decisions among the myriad unknowable facts and with people who become surrogate targets for the anxieties and fears that haunt us. We run the risk of becoming the victim of this conflict just as we could become victim to the fears that envelop us.

Are there better alternatives for dealing with these conflicts? Can we learn in positive ways from our differences and disputes? Can we rise above mere blaming? The answer must be yes. We call it "talk the talk and walk the walk." It is an exercise in interest-based negotiation and conflict resolution that we all can employ.

Resolving conflict on the home front

First, we must sit down and talk with one another about differences that divide us: across religious and ethnic lines; between public officials and private citizens; between different components of the health system that ultimately must collaborate. There already have begun conversations, open meetings and chances for people to meet and discuss these perplexing world events and our reactions to them. These opportunities to engage one another are an excellent response to the extraordinary stress and anxiety that we are experiencing.

"Talk the talk" is about being more committed than ever to opening these lines of communication. To acknowledge our shared stress is to take the first steps of "walking the walk." It is an exercise in negotiating toward decisions and actions based on our shared interests. It is about asking the right questions and really paying attention to the answers.

There are four steps to doing this well. Step one is called "self-interests" -- how we each cope with and respond to current contingencies. Listen intently to what other people are saying and what their real concerns are.

Step two is called "enlarged interests." To address the myriad responses and perspectives that we have developed over time, we step back, grasp the bigger picture and find ways to cope together. We reframe our understanding of our different interests to discover those interests that we share.

Step three is about creative problem solving. It is called "enlightened interests."

This reflects the importance of bringing a fresh way of thinking to unfamiliar circumstances. How will we survive and achieve "normalcy" while being "on high alert?" What are the real risks and the appropriate responses? Think out of the box. Open yourself to new understanding.

Finally, step four is called "aligned interests." How do we align our concerns, objectives and hopes to move positively toward the next and hopefully more peaceful chapter of this current saga? How do we better understand one another and our differences?

"Talk the talk" is about how we conduct ourselves: what we say, what we mean by it and how it translates into our working and personal relationships. "Walk the walk" is about what we do: what we can accomplish as individuals and as a health care system, how we can rise above current challenges and what we will be when this period of conflict is over.

One day, future generations will ask us many questions about what happened now, how we responded and the legacy we left them. We must resist a naive blame game. This is not to say that we should avoid spirited debate about the complex issues that face us. But this is the time to be persistent: engaging with one another in meaningful dialogue, listening and learning as we progress, and seeking wise solutions to the perplexing conflicts that could divide us.

Note: This column originally appeared in print as "Renegotiating Health Care."

Dr. Marcus is director and is associate director of the Program for Health Care Negotiation and Conflict Resolution at the Harvard School of Public Health, 617-496-0867. Dr. Dorn is CEO of Health Care Negotiation Associates 781-861-6116. The paperback version of their book, "Renegotiating Health Care: Resolving Conflict to Build Collaboration," is available for through Jossey-Bass Publishers, 800-956-7739.