"In each hospital there are two types of patients: some of them are seriously ill, others complain about food."
Folk wisdom
Representations of conflict
In order to understand that there is a conflict between the patient and the medical organization, it makes sense to get acquainted with the two established conflict assessment approaches.
I approach (negative). Supporters of this approach estimate the conflict exclusively as a clash (struggle) of opposite opinions, interests, positions. The conflict in this case is regarded as an exceptionally destructive phenomenon, so it is better to be a thin world than a kind quarrel.
II approach (positive). Adherents of this approach perceive the conflict and relate to it as a system of relations, the interaction of subjects with various positions, installations. The conflict, from their point of view, is an integral component of the development of public relations and relations, the natural component of the interaction of people.
From a practical point of view, knowledge of these approaches allows us to develop the right attitude towards any conflict that happens in the team or beyond.
Rules of conduct in any conflict with the patient
In order for between a doctor and the patient, conflicts arose or arose as less as often as possible, medical workers need to be observed a few simple rules:
BUT. No need to postpone the analysis of complaints, claims, expressions of discontent. This is the most faithful way to aggravate the conflict, strengthen the resentment of a person. One of the most unpleasant and insulting the dignity of the person's situations in communication is a demonstration of indifference to the personality of a person, his problems. And since the doctors work with the most valuable thing that there is a person, - with his life and health, then here the indifference is perceived more acute.
B. Remember that the patient is a goal and meaning of your activity, so it cannot interfere, and its problem is not "unimportant." No need to forget and prescribed in the law of truth: "The doctor must respect the honor and dignity of the patient. Rough and inhuman attitude to the patient, humiliation of His human dignity, as well as any manifestations of superiority or expression of any of patients preference or hostility from a doctor are unacceptable "(Ethical Code of the Russian Doctor, 1994).
IN. Each doctor must understand that the clinic is not a place where it is taught, raising and evaluated, this is a place where help to restore health and start living better. One of the most dangerous and destructive habits of the doctor is a tendency to a humiliating for patients comments. Learn, to educate and give assessments of behavior is not only tactlessly and impolitely, but also a guarantee that it will no longer come to such a doctor. No one likes to feel in the role of a student under a formidable look of the teacher, I don't like to justify anyone in front of someone else's person, and yet no one will pay for these feelings your own, blood earned money.
There are situations where the patient for the doctor's incomprehensible for a doctor does not comply with its recommendations, does not fulfill its appointments - and this is connected with the failure of the treatment effect.
In such a situation, the doctor can use the following conversation algorithm:
1) First you repeat your assignments to the patient, the recommendations of the same wording that they were given initially (you can specify in a medical map that the patient signed, which is familiarized) - these are facts, and do not argue with the facts ("WE ARE IN YOU? - Agreed ");
2) Express the sense of own awkwardness (bewilderment, sincere misunderstanding of the motives of the patient's behavior): feelings can not challenge, and it is broadcast by another person - he should be slightly inconvenient ("Sorry, but I may not know something and therefore I can not understand - Why don't you fulfill the recommendations? It seemed to me that we had the overall task - to achieve a result in treatment. But I do not see support from you ");
3) Indicate on the consequences that may occur if the patient does not change its attitude towards health and to your advice. The consequences should be obvious, indisputable and inevitable ("With your passive behavior, we can hardly succeed to achieve planned results, which can lead to ...");
4) Word a constructive proposal ("Let's tell you again I will tell you about what you need to do and what the significance of your actions will have for recovery").
All this will take 4 times longer than the phrase: "Do I need it?!" But the effect of such well-thought-out and built conversation with the patient will be 4 times more: the doctor does not humiliate the dignity of the patient, leading to him negotiations, as with a partner - honestly, directly and confidentially, gently indicating his share of responsibility in the treatment.
G. If the doctor, a representative of the administration or any other medical worker, starting to disassemble the causes of the conflict, misunderstanding with the patient, will come to the conclusion that someone from employees or even he himself really was wrong in relation to the patient, did, it was incorrect, let him not Preminets apologize to the patient (it always causes great respect and even understanding), will explain that he had a very difficult day, complex patients and, perhaps he did not give a person due attention. It is necessary to try to make no more such. Most often, the patient begins to feel at that moment to be guilty due to the fact that he did not restrain and talked and argued, and it was accepted to apologize before the medical worker, soothing him ("Nothing terrible, he, the patient, of course everything understands"). It works.
D. Respect, politeness, tact, calm and goodwill - this is "clothes" of a doctor, without which work cannot be started at all. Respect implies the recognition of the patient's value as an individual and the importance of his concerns, the problems with whom he came to the clinic. In order to demonstrate respect, you need to familiarize yourself with the circumstances of the patient's life so in detail to communicate with him as a personality, and not as a carrier of the disease. When the doctor shows an understanding, the patient is confident that his complaints are heard, fixed in the minds of the doctor. The replicas of the doctor "Please continue", "tell us more about" or just repetition of the heard create a patient feeling that he is listening and want to help.
E. The doctor needs to listen and hear, respecting the patient's right to have his point of view on what is happening regardless of whether it supports it or not.
It seems that it is simply, but, while a person pours offense, discontent, disagreement with something, we most often come up with counterproofs at this time, some answer (preferably a quick and closing theme "on the root"), but just do not listen to it And we are not trying to understand.
What is categorically impossible to do in conflict with the patient:
1) relate to the patient's problem;
2) to contact "you" (the exception is children under 15, after 15 years by law, a person has the right to respect for his medical mystery, has the right to make a decision on his medical manipulations committed against its medical manipulation);
3) demonstrate its superiority, behave arrogantly, arrogantly;
4) assess the behavior and emotions of the patient with the words, expression of the face;
5) Make a patient to wait long.
Additional Board Managing Clinics: Do not be lazy and develop the Ethics Code or enter the "Organizational Culture" section into the rules of the internal labor regulation, containing the rules for interaction with the patient. Once I made a remark to the doctor, two, for the third time you will have the opportunity to make officially reprimand or comment (apply them as disciplinary responsibility).
If the conflict still occurred, read about the tactics of its permission in our following materials.
The materials of books "Legal support of a private medical organization" ( Saligina E.S. M: Statute, 2013) and "Is he schizophrenic?! How to communicate with difficult people "( Lelor Francois, Andre Christoph. M.: Generation, 2007).
The psychological aspect of the conflict is non-critical from a legal point of view, in comparison with the threat of criminal or civil liability. But it constitutes the bulk of violations of the legal rights of the doctor (and as a specialist, and as a citizen). A medical worker is often completely unreasonably accused by patients in all imaginable and unthinkable sins - both their own and the state health care system. During the period of operation such situations, there is a huge number, but there is no single clear protection mechanism from them.
In such a case, much depends on the identity of the doctor himself. If he can, without entering into direct confrontation, use the skills of a skilled psychologist, peacefully resolve the problem - conflict will be exhausted.
Suppose that it is not necessary to resolve the psychological methods. Conflict aggravated.
A patient I intends to appeal against the actions of the doctor, contacting the judicial authorities or police bodies / prosecutor's office. therefore a patient At full of legal grounds, it is entitled to require familiarization with its history of the disease, an outpatient card, as well as make copies from medical and other documents related to its health in the process of obtaining medical services.
The doctor needs to be aware that the patient's actions are to collect evidence of the doctor's inappropriate actions, and may continue to oppose the doctor. This is confirmed by the old truth: "The history of the disease is written for the prosecutor's office."
Here, the doctor can bring him conservatism: acting from conscripts, he either refuse to the patient in familiarization with the documents on the history of the disease, or (alas, such a case) will begin to adjust the medical records than further leads to the risk of conviction for another criminal offense provided for by the Criminal Code of Ukraine - fake documents.
Therefore, the doctor should not exacerbate the situation with refusal. All necessary documents must be submitted to the patient in the manner prescribed by law. As for the content, accuracy of making, reliability and compliance with the data of the diseases of the disease - this every doctor must take care in advance, already in the process of providing medical services, and not at the last moment before the fear of punishment.
Further actions of the patient - appeal. Conditionally, we can distinguish between four objects that may be harmful by unscrupulous actions (inaction) of the medical worker. They are located in descending order from more significant, to less significant:
- the life of the patient;
- patient health;
- labor discipline (the procedure for performing professional duties);
- honor, dignity, business reputation and moral condition of the patient.
Depending on the above, appeal can be carried out in several conditional "directions".
1. Appealing by the patient's actions of a doctor into organs engaged in the medical institution.
Such authorities are the Ministry of Health Protection of Ukraine, local health management bodies, administration of relevant medical institutions. Thus, the patient can:
- contact the head of the medical institution (head physician) with claim (Application), which indicates the actions or inaction of the doctor who violate the legitimate rights of the patient.
- contact management of the health of the district or city or in the Ministry of Health of Ukraine with a complaint, the requirement to consider the circumstances of the case and identify (in the case of) violations at the meeting of the Special Medical Commission.
- make up and send complaint Consumer Protection Office.
In accordance with Art. 20 of the Law of Ukraine "On the circulation of citizens", organization, institutions or enterprises that received written appeal are obliged to respond to it within one month (unless otherwise specified by other, special, regulatory acts).
This is a common rate that obliges a medical institution to provide an answer to patient complaint.
There are some details of this norm. Let's look at them.
In accordance with the full text of the norm, appeals that do not require additional studies are considered immediately, but not more than 15 days from the date of their receipt. In the event that within a month, it is impossible to solve the issues set out in circulation, then the head (deputy) of the relevant authority, enterprise, the organization establishes the required period to consideration ( but not more than 45 days) What is additionally notified by a person who filed an appeal. In the case of the informed written request of the person who has applied, the term of consideration can be reduced.
The response received by the patient may further be attached to the case. If the fact is documented by the patient complaintsBut the medical facility is not confirmed by the fact of the response, this circumstance will be taken into account by the court when considering the case, but not in favor of a medical institution.
Thus, we persistently advise: if a complaint came - it is necessary to answer it! Here's how to answer: formally, briefly, common phrases or in detail, with the application of the documentation, explain the complainant to the specifics of the situation that occurred in its diagnosis or treatment is already a decision of the doctor himself or the head of the medical institution. But you must answer.
In the future, if the doctor's point of view to a specific situation is confirmed by the estimates of other specialists, independent expert assessments or even a medical examination, all this will serve for the court of a strong and objective evidence-based acquaintance of the doctor. In fact, the court may take the formal actions of the doctor (the refusal of the chief physician in the patient's reception with reference to the "scandalivity" of the latter, the absence of a response to the patient submitted complaint, failure to comply with other requests and patient requirements to which he has the right), for indirect confirmation of the doctor's guilt, attempts to conceal the evidence of violations and so on.
2. Appealing by the patient's actions of the doctor's court in the Court of Civil Procedure for the purpose of compensation for damage, (from a doctor / medical institution) suffered from poor-quality treatment, diagnosis and so on.
Appeal in such cases is possible as a doctor's actions in public health facilities and the actions of doctors working in commercial institutions under the contract concluded. The result may be the recovery of damage caused (including moral).
Relations between the patient and the legal entity providing medical services on commercial conditions is based on the contract. It is in the specified civil law contract that all rights, duties, as well as the volume of responsibility of both parties to relationships are properly prescribed. In case of violation of one of the parties to the terms of the contract, the other enjoys its right to appeal to court to prove the fact of violation of the contract and recover the necessary compensation.
In the case of service in the State Medical Institution, the rights, obligations, as well as the scope of the patient and the medical worker, is established from the norms of the Civil Code of Ukraine and other regulatory acts of Ukraine, regulating these relations.
According to the analysis of judicial practice, the requirements of a sufficiently large part of the lawsuits imposed on medical institutions and private doctors are based on the disclosure of medical personnel of information relating to medical mystery. For the most part of the statements of the plaintiffs are confirmed during the judicial debate and providing evidence.
Let's give some clarifications about this.
The fact is that any information released outside the medical institution is quite easily fixed and subsequently can serve as appropriate evidence. The method of disclosing data on the patient can be the publication of an article in a specialized journal, placement of the patient's photos on the site of a private clinic, a message about the diagnosis and forecast of the disease to colleagues on open and closed medical forums on the Internet, in private correspondence, etc.
The claims of patients to recover compensation may be different.
For example, removing the tooth of wisdom, the doctor threw the patient's lupid nerve. The examination came to the conclusion that the doctor made a professional mistake, since the X-ray was not made before the operation. Payment is subject to compensation for damage due to the claim.
Another example (legally, by the way, very controversial). A patient The psychoneurological dispensary requested a certificate for presentation at the place of work (sick leave). The certificate, in accordance with the requirements of the law, contained an angular stamp and round seal with the name of the medical institution - "Psychoneurological Dispensary". Referring to the violation of medical mystery, the individual appealed to the court with a suit to the dispensary, since the fact of finding treatment is the disclosure of information about the appeal of medical care to the institution. The claim was satisfied.
But the fact of receiving a doctor from a patient with a receipt that it is not responsible, and all responsibility is in a patient who agreed with the prescribed treatment is not a 100% guarantee of the doctor's security of possible lawsuits. Although such receipts are taken, their legal importance in court often turns out to be critical consideration. The fact is that in the case of a dispute, the prosecutor may argue that a patient I could not adequately and objectively appreciate the manipulation to which he agreed. That the patient cannot assess the consequences, complications, alternative methods that he can be offered, and the doctor, suppose, did not give him all the necessary explanations. Therefore, such receipts as informed voluntary consent on operations, in courts, after a critical analysis, are not the ideal way to protect the doctor. This is already working for a specialist who owns the skills of medical law, clearly, informatively and fully register the content of the procedure. Only a competently compiled document will help to avoid complaints about the doctor.
What is definitely worth doing - clearly display the essence of the necessary manipulations and medical testimony in the history of the disease.
3. Appeal by the patient's actions of the doctor to the authorities, the criminal case against the doctor in the event of the presence in its actions of the crime.
As a rule, it may mean that it comes to the same court, but in the order of the criminal process. In this case, the victim (his relatives), in the presence of the necessary evidence, appeals with the relevant statements in the internal affairs bodies and / or the prosecutor's office. This is the worst of the options for the development of events (both for the patient and for the doctor), and, as a rule, this occurs as a result of the occurrence of severe consequences - death, disability or severe patient health violations.
"Risk zone" in this case - surgery, gynecology and obstetrics. For example, according to statistics, civil cases for the recovery of physical and non-pecuniary damage in Russia for 2001-2002, claims and complaints Distributed by specialties, approximately in the following order: surgery (up to 25%), dentistry (up to 15%), obstetrics and gynecology (up to 15%), therapy (5-10%), pediatrics (5-6%), traumatology (5%), ophthalmology (4-5%), anesthesiology (5%), ambulance service (2%), Claims for medium medical personnel (5%).
In general, the difficulty of qualifying criminal offenses is related to the specifics of medicine. Human organism is individual, reactions to medicines, on surgical intervention, different. Such reactions are predictable, but at the same time the doctor has to take into account a number of special factors.
Yuri Chertkov
From the book "What is not taught in a medical university"
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In recent years, the number of conflict situations arising between patients and medical clinics has significantly increased.
There are many reasons for this:
- changes in socio-economic living conditions;
- rising legal awareness of the population;
- an increase in the cost of medical services;
- increase the psychological voltage of the population.
As medicine affects the two most important components: the patient's life and health, then without conflicts can not do.
Like many diseases, the conflict is much easier to prevent than stop, so let's analyze typical conflict situations and think about how to avoid them.
Conflict situations:
The patient is afraid
Any employee of the clinic, communicating with the patient, must remember that the disease affects the spiritual peace of mind. The emotional state of the patient at this moment is far from the norm.
The harder the disease, the more it awakens the fears.
Also, it is worth remembering that many people just be afraid of doctors, even if the health problem is insignificant.
Remember that any patient, regardless of whether he calls the clinic or came to the reception, is in a state of increased anxiety.
Perhaps the only way to reduce the patient's concern is to wrap a patient with care: to be calm, spelling with a soft voice, do not fuss and show maximum attention.
The patient does not trust the doctor and clinic
Unfortunately, this is not avoided. The primary patient is always alert toward the doctor. Not only is he at his reception for the first time (the situation can be burdened by fear, see the item above), and he also has a strong prejudice to the professionalism of the doctor (the costs of the post-Soviet past and current realities).
There are patients who do not trust the doctors so much that self-medication prefer. The prejudice of such a patient will be several times higher and to this should be ready.
There are patients "Sali", which before a visit to the doctor read such a number of available information, which have the erroneous perception of the disease and the methods of its treatment. There is not far to dissatisfaction with the actions of the doctor.
What can the clinic do in this case?
Take care of the comfort of patients while taking and waiting for it. If it is stuffy, provide a patient good air access, organize an extraordinary reception if the patient feels worse than others, for example, with a temperature or acute pain. Spread on the table of brochures with interesting information on medical topics. Just without intimidation! Materials should not wake up fear. Remember, the patient is so afraid.
Personal features of the patient
At the time of contact of the patient with any clinic officer, the latter should be remembered that each person has its personal features. And the behavior of the patient, in many respects it will depend on the type of personality, it refers.
What can the clinic do in this case?
Proper construction of communication, reading the patient's personality type and competent timely actions will help prevent conflict situations.
The clinic does not have patient service standards.
Clear actions of clinic staff, prescribed for different situations, allow you to avoid a large number of conflicts.
When the staff of the clinic has a clear understanding, how to behave in one way or another. It is capable of, in a short period of time, evaluate the patient's personal features and tune in to the required level of communication.
You can increase communicative skills at trainings:
and
Summing up the foregoing of the Soviets About how in practice avoid conflict with the patient:
- Comply with the culture of medical care.
- Adhere to the order and standards of service adopted in the clinic.
- Remember the need to diagnose the psychological type of the patient's personality.
- In every way to help a comfortable physical and psychological state of the patient, both during the waiting period and during the reception.
- Be sure to inform the patient about the delay or transfer of the reception.
- Try to resolve the conflict on the site "here and now."
- Be sure to analyze the conflict situation in the labor collective.
Well, in the event that these tips are not enough - contact us!
An analysis of the state of practical medicine indicates an increase in the number of conflict situations between the medical institution and the patient, between the doctor and the patient. Medical staff of the medical institution is in constant condition of the risk of conflict, which can be divided into two groups: conflicts that occurred as a result of medical errors, and conflicts arising from the personal characteristics of the doctor and the patient.
The objective reasons for medical errors include:
- * the impermanence of individual postulates, resulting in the diagnosis of the disease and its treatment;
- * imperfection of medical equipment and technologies used;
- * Not enough clear organization of the medical institution.
Subjective causes of medical errors:
- * lack of sufficient doctor's experience;
- * Imprinting by the doctor of his knowledge;
- * Errors associated with communication.
These subjective causes of medical errors, as well as the personal features of some patients are the causes of conflicts in which the physician's purely medical actions do not have a decisive value. Even if the doctor did everything correctly from the point of view of medicine, legal and psychological mistakes in cooperation with the patient may lead to serious consequences for the doctor and the entire medical institution.
Most often doctors in their practice face interpersonal conflicts. An interpersonal conflict is a conflict between two, less often in three or more personalities (where everyone is "for itself"). Interpersonal conflicts are vertical in which constituent entities of the conflict stand on various steps of the hierarchical staircase, therefore, have different rights and powers, and horizontal - between equal in opponent status.
The intrapersonal conflict arises when the problem of choice, which he cannot do in front of a person. This is a struggle of needs and social conditions, desires and restrictions, necessity and opportunities, this dispute between "I want" and "it is impossible", between "should" and "I do not want." With disability due to injury or serious illness, intrapersonal conflict may be expressed in a growing inconsistency between needs and reduced capabilities. If the nurse at the same time give contradictory orders the senior nurse, the doctor and the head of the department, this can cause emotional tension. Each of us faces dilemmas to linger at work, as required by the production need, or rush to the institute where your presence is required? Is it to work for a job for which they pay a lot, but it will not leave the family time? If "for" and "against" for you is equal and difficult to make a choice, you encountered intrapersonal conflict. Inability to resolve intrapersonal conflicts to increasing emotional stress, aggression. In the development of autoagression, the person "leaves" into the disease, or, directing aggressiveness internally, discharged on others (then the intrainarial conflict develops into interpersonal).
If the interpersonal conflict is not permitted in one way or another, its participants are asked for support, recruit supporters, and the conflict develops into an intergroup or conflict between the person and the group.
The conflict between the person and the group as a consequence of an interpersonal conflict arises when one of the participants has found support for its position: it may be a conflict between the patient and the medical staff or the doctor and relatives of the patient, etc. This type of conflict may occur when the person does not accept group values, does not adhere to the norms of the behavior adopted in the group, the institution, does not meet the social expectations of the group, that is, comes "with its charter in a foreign monastery." Examples can serve as a young doctor that makes one of the typical errors in the device to a new job, when a new employee transfers its previous stereotypes to new conditions: "And we were taught so!", "Your methods are outdated!", Or a patient who insists on the change orders headed in the hospital or clinic. At the same time, unfortunately, the conflict arises regardless of whether or not the "reformer" is right.
The cause of the conflict between the person and the group may also be the conflict between the head and subordinates, when the first occupies an authoritarian position, not believing with opinions, desires, the needs of workers. Usually, first such a conflict occurs in a hidden form, breaking through individual, local flashes. If the manual does not notice and will not take action on clarifying and solving this situation, the conflict may lead to disastrous consequences.
Meet health facilities and intergroup conflicts. These are religious and national conflicts, as well as conflicts between scientific schools or employees of various departments in the hospital. The intergroup conflict arises between the groups and between the microGroups inside one team, for example, between different formal groups, between formal and informal, between informal groups. Thus, the daily change of medical personnel can accuse the night shift in that she does not care for the sick, or similar complaints are presented to each other small groups inside one team.
In particular cases of intergroup conflict include conflicts between the two participants in which the claims make not a specific patient or a doctor, but in his face a whole social or professional group ("You, doctors, only money you want, and do not know how to treat," in your hospital Never about the order "," You, patients who do not follow health, and then demand a miracle doctors. ") The complexity of the permission of such a conflict is that one person is unable to respond to the whole team, but in order to identify from generalized claims Specific problem, it takes time, good communication skills and stress resistance.
The causes of conflict situations in medical practice can be the most diverse. In the conflict of values, disagreements concern the value-semantic aspects of interaction. For example, its participants can understand the meaning and goals of joint activities in different ways. For example, for a doctor, the patient's health is valuable and significant, and the patient is currently more concerned about its performance, that is, the need to be at work, perform professional functions to harm their own health, and it is looking for symptomatic treatment. Or for one employee of the hospital, the doctor's profession is a real calling, so it works enthusiastically, constantly improves his skills, seeks to treat patients as much as possible as possible, and the other doctor is not interested in self-realization, therefore uninitiativen, although performing the amount of work. Contradictions here affect not the norms of behavior, but the value-semantic aspects of being. It does not mean at all that different value installations inevitably lead to conflicts. People can successfully interact and have good relationships, despite the difference in their value ideas. The conflict arises when someone begins to invade the sphere of values \u200b\u200bof another person, without recognizing the freedom of personal choice. Usually conflicts of values \u200b\u200bbetween the doctor and the patient are resolved by compliance with bioethic principles.
When conflict interests are possible two options. If interests coincide, and the participants claim some limited material factors (place, time, room, monetary reward), then such a conflict can be called a resource. Each party is interested in obtaining the resource needed (financing, new equipment) or more favorable (by quantity or quality) part of the resource. They strive for the same, they have the same goals, but due to the limited resources, their interests contradict each other. This type of conflict includes all situations affecting the problems of distribution or arising on the basis of rivalry for possession of anything.
Another option occurs when colleagues have interests contrary to each other. Due to the interaction of people in this situation, they are volunteer or involuntarily become an obstacle to each other in the realization of their interests. (For example, part of the clinic team agrees to increase its qualifications in non-working time, and some doctors do not want to sacrifice family and personal interests.) The incompatibility of the interests of the doctor and the patient seems impossible, because both should be interested in recovering the patient or facilitating his suffering But it is, unfortunately, the perfect option.
Interaction participants can share common values \u200b\u200band common goals (interests), but have different ideas about how to achieve them. The conflict of means of achieving the goal occurs when the patient, for example, agree with the diagnosis, is ready to be treated, but disagree with the treatment plan developed by the doctor. If you concentrate on what consent is, to solve the conflict of means of achieving the goal is much easier. Sometimes people peacefully coexist, having even various value installations, but if the ways to implement the goals elected by one of them are damaged to the general interaction or someone from its participants, problems arise. You can safely treat the fact that someone next to you fulfills your duties not as you do, but when he is trying to put part of his work on you, a conflict situation arises.
Conflicts of inconsistencies associated with the potentials of participants in the interaction and their compliance with the requirements of them can take various forms. This is possible when anyone because of incompetence or, for example, physical disability cannot make the necessary contribution to the common cause. Situations of this type are well known: one or more employees, without cope with their duties, allow mistakes than make it difficult to work the entire team. Another type of these conflict situations is associated with a significant gap in intellectual, physical or other potentials of different participants in the interaction. The situations of this type arise due to the fact that the overall result of activity is made up of the amount of individual efforts, and the "weak link" or impairs the overall result, the image of the clinic, or even becomes an interference in some actions.
Conflicts of interaction rules associated with any violation of adopted standards or established rules from the participants are possible if this violation damage the normal interaction or relationships of people. This includes situations of disagreements due to non-fulfillment by people of obligations to others, violations of generally accepted etiquette or norms adopted in this group, exceeding any of their rights.
Such conflicts may arise from the desire of someone from the participants in cooperation to revise the rules and rules or the redistribution of power or duties: an increase in the rights of one and reducing the rights of others, the change in the rules in the current system, etc.
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