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Reflections of a soon-to-be Consultant: How mediation changed my career.

by Dr Gamunu Ratnayake

“Urgh that family is so difficult, I hate dealing with them!”

“This patient is such hard work, why won’t they just listen!”

“I don’t understand why they are going against my advice, if they did what I suggested it would be so much better for them.”

“I’m pretty sure that family is going to make a complaint.”

“He/She is so difficult to work with.”

“They are so unreasonable!”

“I hate working with that team!”

Over the last 13 years I have had the privilege of working as a Respiratory and Intensive Care registrar before re-training as an Anaesthetist. I am currently an ST7 in Anaesthetics at the Evelina Children’s Hospital. I found out about mediation quite by accident. I was interested in Medical Law and was considering a conversion course. Whilst discussing the conversion course with a lawyer, they mentioned that many of their most successful cases never got to court. Instead by using mediators, they took antagonistic (even hostile) situations between families and clinicians and resolved them so that both sides felt heard and understood. This sounded like the Holy Grail to me. So I embarked on training as a mediator, to learn these transformative skills.

Over my career working in A&E, on the medical wards, theatres and Intensive Care I can honestly say that the above quotes have run through my mind (and even slipped past my lips) on more than one occasion. In fact, if you work in healthcare I would be surprised if you have not at least thought the same yourself. Since learning the skills of mediation 2 years ago, these thoughts barely register. It has allowed me to better understand my patients and their families and given me new insight into what people value. In addition, it has helped me to understand my colleagues and be a more effective team member. In short, the skills I have learnt in mediation have made me a better clinician.

This begs the question… what is mediation? There are many erudite definitions in textbooks, but I simply see it as listening and understanding the viewpoints of others. Moreover, it is about letting them feel heard and valued. Mediation utilises a variety of techniques including analysing body language, eye-contact and silence. This gives people time and space to express themselves. Techniques such as reflection and summarising help to validate people’s feelings. So many conflicts in work (and in personal life) stem from a feeling of not being heard. Mediation gives you the tools to make people feel understood. Moreover, by helping to solve or even prevent conflicts it can mitigate the negative effects on clinicians. Any dispute with a family or the patient would often leave me nervous, unsatisfied and even with difficulty sleeping. We all want to do what is best for our patients, and tension with families or the patient certainly make us feel like we have failed. Mediation skills have been invaluable in preventing that tension and therefore avoiding that horrible feeling of failure.

Healthcare is a unique situation where everyone (the patient, their family, and the clinicians) have the same goal – to do what’s best for the patient. Mediation is more than resolving conflicts. With the skills of mediation, you can avoid clashes occurring the first place! This is why I passionately believe all healthcare professionals should master these techniques.