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Hospitalists face the potential for conflict every day. They work in highly complex organizations in which in order to be successful they must interact effectively with a wide variety of individuals in what is often a challenging, emotionally charged environment. They must learn to navigate not only the formal organizational bureaucracy of rules, systems, and processes, but also the informal political hierarchy that influences power and decision making. Often, they must do so with little or no formal training in conflict management at an early stage in their medical careers. In addition, they may encounter conflicts between what referring physicians would like them to accomplish during hospitalization and the needs of the hospital to expedite care to the outpatient setting.

Hospital Medicine is also a young, evolving specialty that has enjoyed unprecedented exponential growth by serving the needs of multiple competing stakeholders. Few mentors or seasoned clinicians have specialized in Hospital Medicine, and as such they may not have a complete understanding of the specialty or even have career advancement of hospitalists on their radar screen. The potential exists for the service obligations of hospitalists to overwhelm opportunities for professional development, and this may promote career dissatisfaction, turnover, and symptoms of burnout. Leaders of hospitalist services may find themselves isolated as they advocate for the professional development of members of the service while meeting the service expectations of their employers or supervisors. The professional medical society for hospitalists, the Society of Hospital Medicine (SHM), is rapidly developing flexible support resources for hospitalists relating to business practice, career satisfaction, core competencies and role expectations. Until these standards become widely disseminated and health care services become better designed and hence less prone to error, hospitalists will continue to work in a hospital environment where they will increasingly be expected to perform as change agents at a time when change may not be welcome by others at their institutions.

For the purposes of this chapter, it will be important to distinguish between disagreements and conflicts. Disagreements happen regularly in human interactions, and occur whenever two or more individuals have differing opinions about something. A disagreement need not devolve into a conflict, and many do not. Conflicts arise when a party perceives that another party has negatively affected or will negatively affect agendas that the first party cares about. Conflicts are defined as processes that occur when tensions develop, that is, the emotions associated with a disagreement become so elevated that they impede the ability of the parties to interact with each other effectively.

Almost all conflict is a result of unmet expectations. For hospitalists, this commonly arises when there is a lack of understanding or a difference in expectations about the role of hospitalists. Hospitalists may assume that primary care physicians have explained to patients that someone else will be seeing them in the hospital. Patients and families, however, may not understand why their primary care physician is not present in ...

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