This information guide is intended
for consultant psychiatrists and trainees in psychiatry who are
experiencing difficulties with their colleagues. This information
should be used as a guide only and it is not a substitute for
professional advice. This leaflet does not cover dealing with
disciplinary matters or with criminal behaviour.
Relationships with colleagues
Trust is an essential component of
good interpersonal relationships. Individuals vary in their
capabilities in forming and sustaining relationships. Furthermore,
early personal experiences shape later relationships. For example,
elements of ‘sibling rivalry’ may occur in the interactions between
colleagues of similar seniority. Similarly, the relationships
between senior and junior colleagues may resemble ‘parent and
child’ relationships (Garelick & Fagin, 2004).
Individuals vary in their personal
characteristics and in their capacity for emotional
self-regulation. At work, emotions can surface such as anger,
frustration, disappointment, anxiety, fear, envy and jealousy. They
may appear as behaviours such as rudeness, impatience, obstruction,
hostility to patients or staff, or as difficulties with colleagues.
Emotions may be projected onto others, who in turn experience the
emotion through transference, ‘projective identification’ and
‘splitting’ into good and bad ‘objects’. Effective leadership and
clarity of boundaries can enhance the stability of staff
relationships within organisations (Garelick & Fagin,
During interpersonal difficulties, colleagues may employ various
defence mechanisms to cope with or relieve stress. It is important
to recognise that this may delay or even prevent the resolution of
underlying problems. The following examples are adapted from
Steinert (2008): · Denial: makes excuses for the person, thus fails
to accept that the problem exists · Displacement: undertakes more
clinical work, so avoids or delays investigating and tackling the
issues · Reaction formation: becomes angry and frustrated, blames
the other person, loses objectivity and does not tackle the cause
of the problem · Sublimation: wants to rescue or protect the
individual, may take on more work to avoid exposing the other
person to challenges, rather than addressing the underlying
Relationships between peers
At work, many factors can lead to difficulties between those of
the same or similar grade (Garelick & Fagin, 2004). Colleagues
tend to compare their workload (e.g. case-load, on-call duties,
complexity of work), their working environment (e.g. office,
furnishings, clinics), resources (e.g. number of skilled team
members, dates of annual leave, opportunities for training and
personal development, financial remuneration for similar work and
monies for services), and support (e.g. from local managers,
tutors, trust management) (ibid.).
Relationships between seniors and
A ‘Problem’ senior can affect trainees in any
of their senior roles as a teacher, team leader, mentor, clinical
supervisor and manager. Underlying causes can be similar to those
listed above and additional factors include:
- situation: working in a dysfunctional team
or organisation, the senior and/or trainee react to the dynamics
and behave badly
- personal problems: overwork, stress at work
and/or at home, isolation and ill health
- attitude: trainee makes an error or fails
their exams, leading to trainee being viewed as incompetent or
- behaviour: senior is critical, undermining
- boundaries: senior makes sexual advances,
hurtful jokes, bullies or ridicules trainee (alone, in presence of
peers or team members)
- selfishness: senior loads trainee with work,
takes all school holidays for self, absent from the service so
trainee lacks supervision and training (adapted from Gray,
A ‘Problem’ trainee may have
problems in one or more areas of their life which can be
long-standing or recent. They may present with ‘difficult’
behaviours or poor standards of work. It is essential to find the
underlying causes and contributing factors (National Association of
Clinical Tutors, 2013).
Trainees may have problems with:
- knowledge: lacks sufficient basic medical or
- attitude: lacks understanding of others’ and
own behaviour, lacks motivation, feels challenged, is anxious or
fearful, does not seem to enjoy psychiatry
- skills: has poor clinical judgement, poor
organisational skills, problems with time-management, poor
interpersonal or technical skills
- personal life: relationship problems,
financial difficulties, substance misuse, loneliness, emotional
difficulties, problems with travel, fatigue, mental or physical ill
health (adapted from Steinbert, 2008).
Health of organisations
Sometimes difficulties between colleagues are generated by
problems within organisations. The health of organisations
fundamentally affects the working relationships within and between
professional groups (Obholzer & Roberts, 1994). Common system
problems affecting staff include having unclear standards and
responsibilities, excessive workloads, complex patients, lack of
feedback or appraisal, as well as lack of resources and lack of
support for a particular role, for example as a teacher (Steinert,
2008). Organisation can have a culture of fault-finding, criticism
How to deal with difficult colleagues
Chances of success in changing behaviours: three
First decide whether you are likely to succeed in getting this
‘difficult colleague’ to change their behaviour towards you by
asking these questions (Houghton, 2005):
- Has this person taken an active part in
causing the problem?
- Does this person consistently cause
- Is there a consensus that this person
generally causes problems?
If the answers are ‘yes’, Houghton advises asking yourself what
the chances are that this person will modify their behaviour for
you. The following tips may help you to decide how to proceed.
Assessment (adapted from Garelick & Fagin,
- What is the difficulty?
- What are the issues (specific or general, type)?
- Why has the problem arisen?
- Is it affecting other people?
- Is it a professional or performance issue?
- Is it a personal or an organisational issue presenting as a
- Has anyone else had similar difficulties?
- What was the situation before the current difficulty?
- What is the nature of the relationship between the parties
having difficulty (peers, senior and junior, other)?
- What has already been tried to resolve the situation?
- Who could you approach for advice and support?
- Are you being bullied or are you whistle-blowing? (see the
Psychiatrist Support Service guide 6 On Bullying and Harassment,
and guide 3 On Whistle-Blowing and Passing on Concerns)
The GMC has guidance on Raising and acting on concerns about
patient safety (2012). Recommended reading: Understanding doctors’
performance by Cox et al (2006).
Managing difficulties between colleagues
(Adapted from Garelick & Fagin, 2004)
- Don’t avoid the issue hoping it will go away
- Try to see the difficulty from the other person’s
- Have an informal chat over a cup of coffee with a friend or
- Share the problem with an independent and trusted
- Find time to deal with the issues
- Find a local supporter/mentor
- Be prepared to learn from your mistakes.
Managing difficulties in trainees
A framework for the management of trainees in difficulty is
available from the National Association of Clinical Tutors (2013).
The process includes:
- assessing trigger or event (Is patient safety affected? Does
this really matter and need attention? Do you need advice about
this? Who is the best person to give advice?)
- defining the problem (investigate and collect information from
several sources; keep records and avoid reaching hasty
- deciding whether the cause is an individual or organisational
issue, or both.
A framework for managing trainees in difficulty in Scotland
includes 10 guiding principles, a classification system and
examples of resources for remediation (Anderson et al, 2011).
For serious concerns
- Seek advice from the clinical and medical directors
- Consider contacting the human resources department
- Keep records of events, contacts and actions taken
- Obtain advice from your defence organisation
- For advice and support on resolving performance concerns about
doctors, dentists and pharmacists, contact the National Clinical Assessment
The Psychiatrists Support Service
The Psychiatrists' Support Service is a free,
confidential support and advice service for psychiatrists at all
stages of their career who find themselves in difficulty or in need
of support. The service is available during office hours Monday to
Friday. To contact the service, telephone: 020 7245 0412 or email:
- ANDERSON, F., CACHIA, P.G., MONIE, R., & CONNACHER, A.A.
(2011) Supporting trainees in difficulty: a new approach for
Scotland. Scottish Medical Journal,
- COX, J., KING, J., HUTCHINSON, A., MCAVOY, P., Understanding
Doctors’ Performance, Radcliffe Publishing. Oxford, 2006.
- GARELICK, G. & FAGIN, L. (2004) Doctor to doctor: getting
on with colleagues. Advances in Psychiatric Treatment,
- GMC 920120 Raising and acting on concerns about patient safety.
Last accessed: 15.04.17
- GRAY, C. (1997) Dealing with difficult bosses. BMJ
Careers, 314, 2.
- HOUGHTON, A. (2005) Personal support 4: Helping each other deal
with tricky relationships. BMJ Careers,
- NATIONAL ASSOCIATION OF CLINICAL TUTORS (2013) Managing
Trainees in Difficulty (version 3). Practical Advice for
Educational and Clinical Supervisors. NACT UK
- OBHOLZER, A. & ROBERTS, V. Z. (1994) The Unconscious at
Work: Individual and Organizational Stress in the Human Services.
- STEINERT, Y. (2008) The ‘problem’ junior: whose problem is it?
BMJ, 336, 150–153.
Copyright: The Royal College of Psychiatrists 2017
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