How Physicians Can Navigate Conflict with Integrity

If you ask physicians what drains them most, the answer isn’t always workload, RVUs, call, or EMR clicks. For many, it’s an atmosphere of dysfunctional work relationships. The fake niceties at meetings. The passive-aggressive emails. The partner who gossips instead of addressing concerns directly. These fractures erode trust, worsen burnout, and weaken the culture we rely on to deliver safe care.

The question isn’t how to eliminate conflict. The question is how to relate to one another with integrity while maintaining healthy boundaries and a willingness to engage in necessary, honest conversation. To do that well, it helps to understand a few core concepts.

1. Discourse is not a threat. It’s part of being human.
Disagreement is natural and necessary. It’s how humans innovate, refine ideas, and solve complex problems. What derails us isn’t the friction itself but our fear-based reactions: people-pleasing, appeasing perceived power, and mounting a full-blown fight-or-flight response every time a message from leadership appears in our inbox.

Residency didn’t just teach us how to care for patients. It taught us to become discourse-averse. We learned to keep our heads down, do the work, and ask no questions. We were socialized to avoid rocking the boat for fear of being labeled “not a team player.” We kept ourselves small because we believed it was necessary for survival.

But we’re not in training anymore. It’s time to welcome disagreement as a normal, healthy part of our professional lives.

2. What our colleagues believe is sacred to them.
And our beliefs are sacred to us. Respecting that is internal work. Before entering a difficult conversation, pause to remind yourself, What they believe is sacred to them, and it is not a threat to me shifts the emotional landscape.

Consider a familiar scenario: your senior partner alludes to the fact that she wants everyone to stay in clinic until 5 p.m. without explicitly saying it, even if all your messages are addressed and notes are done. Instead of sneaking out the back door at 4:50 or simmering in quiet resentment in your office, assume good intent. She believes it’s her responsibility to ensure the office is covered until closing. You don’t have to agree, but you can honor that it matters to her.

A grounded conversation might sound like:
“Can we talk about clinic coverage? My understanding is that you’d like me to stay until 5 in case something comes in. Is that accurate?”
After looping for understanding:
“The PAs are here until 5, and everyone has my cell. If you’re comfortable with it, I’d like to leave once my notes are done. I’m happy to come back if anything urgent comes in.”

This approach preserves both relationship and autonomy.

3. Move from the Drama Triangle to the Empowerment Dynamic.
The drama triangle includes three roles: victim, villain, and hero. We fall into these roles automatically, especially under stress.

Say you learn that a colleague has been speaking unkindly about you behind your back. In your story, you become the victim and they become the villain. You feel attacked, misunderstood, and powerless. You vent to friends, simmer in indignation, or avoid the colleague altogether.

But in their story, the roles are completely reversed. They might believe they are the victim and you are the villain. Maybe they misinterpreted something you said in a meeting. Maybe they’re carrying insecurity from an unrelated situation and projecting it onto you. 

Alternatively, they may see themselves as the hero, protecting their sense of indispensability in a system where status feels fragile. This is how scarcity and hierarchy shape our inner narratives in medicine. In a culture where opportunities, praise, OR time, and leadership roles seem to be limited, zero-sum thinking thrives. If someone else is rising, it must mean you are falling. If another physician in your group is very well-liked, it must diminish your value. 

In that psychological landscape, even minor misunderstandings can morph into power struggles. People tear others down not because they are malicious, but because the culture has quietly taught them: there is not enough respect, recognition, or promotions to go around.

Until we see these scarcity-driven narratives for what they are - internal stories shaped by the environment, not truth - we stay trapped in drama instead of moving toward productive, empowered dialogue.

The Empowerment Dynamic offers an alternative. Here, the villain becomes the challenger, the hero becomes the coach, and the victim, the creator. This shift changes everything.

Instead of viewing the colleague who has been gossiping about you as a villain, you can choose to see them as a challenger. Challengers reveal what you value. In this situation, you may notice how much you care about respect and authenticity.

From there, step into the role of the creator and ask yourself, How do I want to feel about this, in a way that supports my goals and integrity? This doesn’t mean bypassing your real emotions. If you feel angry, indignant, or hurt, acknowledge those feelings. Name them, let them move through your body, and give yourself permission to have a human response.

Once grounded, you can reverse engineer a solution that moves the relationship forward instead of getting stuck in drama. That might look like initiating a direct but steady dialogue:

“Can we have an uncomfortable conversation? I’ve heard you’ve said some unkind things about me. If that’s true, can you help me understand what’s behind it?”

Approached from curiosity instead of threat, the discussion becomes an opportunity for clarity, repair, and honest connection.

This shift matters because culture matters.
Physicians cannot afford to spend their energy on interpersonal cold wars, gossip spirals, and unspoken resentments. When we step out of the drama triangle, we change the relational fabric of our clinics and ORs. We show trainees a different model. We create workplaces where respectful discourse, not pretending, becomes the new normal.

We cannot control how our colleagues behave. But we can choose how we show up.And that choice - toward candid conversations and authentic interactions - is what transforms dysfunctional cultures into functional ones.