How to deal with a difficult colleague in the NHS

• “Difficult” is often a description of an interaction rather than a complete description of a person.
• Behaviour that feels personal may be influenced by workload, stress, competing priorities, communication style, insecurity or organisational pressures.
• It is usually more productive to describe observable behaviour than to make assumptions about personality or intention.
• Assertiveness means being clear about concerns, needs and boundaries without becoming aggressive.
• Many conflicts become easier to resolve when the conversation moves from fixed positions to the interests underlying them.
• Repeated intimidation, bullying, discrimination or behaviour affecting patient safety requires a different response from an ordinary interpersonal disagreement.
• The aim is not to win an encounter with a difficult colleague, but to find the most constructive and proportionate way forward.

Almost everyone who works in healthcare will eventually encounter a colleague they find difficult.

It may be the consultant who dismisses other people's opinions, the registrar who responds aggressively when challenged, the nurse who repeatedly undermines a junior doctor, the manager who seems impossible to pin down, or the colleague whose communication is so abrupt that every interaction becomes uncomfortable.

Sometimes the problem is obvious. At other times it is more subtle. Nothing overtly unacceptable may have happened, but every conversation feels strained. Requests are interpreted negatively. Emails acquire unintended meanings. Each person begins anticipating difficulty before the conversation has even started.

Healthcare creates particularly fertile conditions for these problems. Teams operate under pressure, roles overlap, priorities compete and decisions frequently have to be made with incomplete information. Hierarchy remains important, but clinical work is also highly interdependent. Doctors, nurses, pharmacists, managers, therapists and many other professionals may all need to cooperate to achieve a single outcome.

The GMC's guidance on working with colleagues emphasises the importance of respecting colleagues' skills and contributions, communicating effectively and ensuring that responsibilities between teams are clear. (ISC Medical)

This is why workplace conflict in healthcare cannot always be dismissed as a matter of personality. A difficult relationship may remain a private irritation, but once communication deteriorates sufficiently it can begin to affect the team around it.

It is tempting to think of difficult colleagues as a particular category of people.

That is rarely helpful.

Some behaviour is clearly unacceptable, and there are circumstances in which an individual repeatedly behaves badly towards several colleagues. Many workplace difficulties, however, arise from the interaction between two people rather than from one person simply being “the problem”.

A colleague who appears inflexible to one person may be seen by somebody else as meticulous. Someone perceived as aggressive may regard themselves as direct. The doctor who seems obstructive may believe they are protecting an overstretched service. A manager viewed as bureaucratic may be working within constraints that the clinical team does not see.

This does not mean excusing poor behaviour. It means avoiding an early mistake: turning a description of behaviour into a judgement about character.

There is an important difference between saying:

“She is impossible.”

and:

“When I raise a concern, she interrupts before I have finished explaining it and often dismisses it without discussion.”

The second description gives you something concrete to work with. The first does not.

Once someone has been mentally classified as difficult, future behaviour tends to be interpreted through that lens. Neutral comments begin to sound hostile. Ambiguous emails seem deliberately obstructive. The relationship can then become self-reinforcing.

A more useful starting point is to define what is actually happening.

One of the most common causes of escalation is assuming that we know why another person behaved as they did.

A consultant gives an abrupt response and it becomes evidence that they do not respect you. A colleague does not reply to an email and it becomes evidence that they are deliberately ignoring the issue. Somebody challenges a decision in an MDT and it is interpreted as an attempt to undermine you.

Those explanations may be correct. They may equally be wrong. The distinction between impact and intention is therefore important. The impact of someone's behaviour can be real even when their intention is unknown. An abrupt manner may make colleagues reluctant to approach them whether or not they consciously intended to intimidate anyone. This allows a difficult interaction to be addressed without having to establish motive.

A useful conversation therefore focuses on what occurred and its effect:

“During the meeting, I was interrupted several times while presenting the case. I found it difficult to explain the clinical reasoning fully, and I'm concerned that we didn't properly consider that part of the discussion.”

That is very different from:

“You deliberately tried to undermine me in the meeting.”

The first can be discussed. The second immediately creates an argument about intention.

Difficult behaviour rarely occurs in a vacuum. Understanding its possible drivers does not make unacceptable conduct acceptable, but it often determines how best to respond.

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Pressure and workload

People under sustained pressure can become less patient, more abrupt and less tolerant of ambiguity.

This is particularly relevant in healthcare, where staff may be managing clinical risk, staffing shortages, long waiting lists, rota problems and competing demands simultaneously.

A colleague's response may therefore be partly about the circumstances in which the conversation is taking place.

Timing matters. A conversation attempted while someone is managing three urgent problems is likely to be very different from the same conversation held later in private.

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Competing priorities

Many apparently interpersonal conflicts are actually disagreements between priorities.

A clinician may want an investigation completed urgently. Another department may be trying to preserve capacity for even more urgent work. A trainee may want an educational opportunity while the consultant is focused on throughput. A manager may be concerned about resources while the doctor is primarily concerned about an individual patient's needs.

Both sides can believe the other is being unreasonable when they are actually optimising for different things.

Making those competing priorities explicit can change the quality of the conversation considerably.

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Different communication styles

Some people communicate indirectly and diplomatically. Others are concise and highly task-focused. One person may value discussion and consensus, while another prefers a rapid decision. Neither approach is inherently wrong, but mismatches can create considerable friction.

A highly direct colleague may experience a more diplomatic communicator as vague or indecisive. The diplomatic communicator may experience the direct colleague as rude or dismissive.

Recognising these differences can help without requiring either person to adopt an artificial personality. Effective professionals learn to modify their communication sufficiently to work with people whose natural style differs from their own.

Doctors and other healthcare professionals who want to explore this much more broadly may find ISC Medical's Advanced Communication Skills Course useful. The two-day live course looks at communication with patients and colleagues, including rapport, listening, empathy, communication styles, managing expectations, conflict and difficult interactions.

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Insecurity and defensiveness

Difficult behaviour sometimes appears when people feel threatened. Challenge, feedback or uncertainty can activate defensiveness, particularly when professional identity is involved. Doctors spend years developing expertise, and being questioned in an area closely associated with that expertise can feel more personal than intended.

This is one reason public confrontation often goes badly. Where possible, difficult conversations are usually more productive when they allow the other person to retain dignity rather than forcing them to defend themselves in front of colleagues.

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Previous history

Some difficult interactions are not really about the current issue at all. A series of unresolved disagreements can accumulate until each new problem carries the emotional weight of everything that happened previously. At that point, even a relatively minor incident may produce a disproportionate response.

Resolving the immediate practical issue may not be enough if the relationship itself has deteriorated. A more explicit conversation about how the two people work together may be necessary.

This is often the least comfortable part of conflict management. It is easy to analyse what the other person is doing badly. It is harder to examine our own behaviour with the same degree of scrutiny.

This does not mean assuming equal responsibility where none exists. Some behaviour is clearly inappropriate and some relationships involve significant power imbalances. Self-reflection is not the same as self-blame. It does mean considering whether anything in your own approach is unintentionally making the situation harder.

A person who repeatedly complains that colleagues become defensive may need to consider how they deliver challenge. Someone who feels they are never listened to may need to examine whether they choose the right moment to raise issues. A doctor frustrated by a manager's refusal may discover that they consistently present clinical need without acknowledging operational constraints.

Tone, timing, body language, email style and the degree of certainty with which a position is expressed can all influence what happens next.

Good conflict management therefore requires enough self-awareness to modify your own approach without automatically surrendering your position.

Conflict becomes harder to resolve once the objective changes from solving a problem to proving that one person is right.

This happens surprisingly easily. A disagreement begins over a rota, referral, procedure or management decision. After several unpleasant exchanges, the original problem becomes secondary. Both people are now defending themselves.

A more productive approach keeps returning to the practical issue that needs resolving. This can be particularly important in healthcare because there is often a shared objective even where there is profound disagreement about how to achieve it.

Two doctors arguing over discharge may both be trying to provide safe care but differ in their assessment of risk. A clinical team and service manager may both want a sustainable service while disagreeing about capacity. Two specialties may both be concerned about the same patient while viewing responsibility differently.

Identifying common ground does not eliminate disagreement, but it changes its context.

People in conflict often state positions.

• One person wants the patient admitted. The other says no.
• One doctor wants additional clinic capacity. Management says there is none.
• One trainee wants to attend a course. The rota coordinator says the leave cannot be granted.

Positions are difficult to negotiate because they are binary. Behind positions, however, are usually interests.

The doctor seeking admission may be worried about deterioration at home. The receiving clinician may be concerned about inappropriate admissions overwhelming an already unsafe service. The trainee may need evidence for progression. The rota coordinator may be trying to maintain minimum staffing.

Once the underlying interests become visible, additional solutions sometimes emerge.

The conversation moves away from forcing somebody to abandon their position and towards understanding what needs to be protected on both sides.

Assertiveness is frequently misunderstood as simply being more forceful. It is better understood as the ability to communicate a position clearly while respecting the other person's legitimate interests and boundaries.

Assertive communication allows disagreement to remain disagreement without turning it into hostility. It is direct enough that the message cannot easily be misunderstood, but measured enough that the other person is not unnecessarily pushed into defence.

For people who specifically want to develop this aspect of their communication, ISC Medical's Assertiveness and Influencing Skills Course explores assertiveness, personal power, influencing styles, language, rapport and adapting your approach to different people. It combines four e-learning modules with a live interactive webinar. (ISC Medical)

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Be specific about the behaviour

Vague criticism is difficult to act on. Comments such as “your attitude is a problem” or “you need to communicate better” give the recipient very little useful information.

Specific examples are much harder to dismiss and much easier to discuss. Describing the behaviour, its context and its impact generally produces a more useful conversation than making global statements about somebody's personality.

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Say what needs to change

A complaint without a request often leaves both sides knowing there is a problem but not what resolution would look like.

If interruptions are the problem, the practical request may be to allow each person to complete their explanation before responding.

If decisions are repeatedly being changed without communication, the request might be for agreed decisions to be discussed before they are altered.

Clarity reduces the likelihood that the conversation becomes merely an exchange of grievances.

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Listen properly to the response

Assertiveness is not delivering a perfectly constructed statement and then waiting for the other person to agree.

The other person may have information you do not have. They may experience your behaviour very differently. Their interpretation may be uncomfortable to hear but still contain something useful.

Listening does not require agreement. It does require enough curiosity to understand their perspective before deciding what to do with it.

Many difficult conversations fail before they begin because they take place in the wrong environment.

Public challenge can be necessary when an immediate clinical risk must be addressed. Most interpersonal difficulties, however, are better discussed privately.

A rushed corridor conversation, an argument in front of the MDT or an emotionally charged exchange immediately after an incident can make resolution less likely.

Where there is no urgency, allowing some emotional distance can help. Too much delay can also be counterproductive, particularly if resentment is building, but the aim is to hold the conversation when both people have enough capacity to engage with it.

Email deserves particular caution. Written communication is valuable for factual information and documentation, but it is often a poor medium for resolving emotionally complex disputes. Tone is easily misinterpreted, increasingly long email chains encourage point-by-point rebuttal, and copying additional people into the exchange can turn a disagreement into a performance.

Sometimes the most useful response to an escalating email thread is to stop writing and speak.

Difficult conversations often have a moment at which they either become more constructive or begin to escalate. Recognising that point is an important skill.

If someone becomes defensive, responding with greater force rarely makes them less defensive. If their voice rises, matching it generally increases rather than reduces the intensity.

Keeping your own pace and tone controlled can alter the dynamics of the interaction.

Acknowledgement can also help. Acknowledging another person's frustration does not require conceding the substance of the disagreement. It simply demonstrates that you have heard it.

Statements such as “I can see why this has been frustrating” or “I understand that you're under significant pressure from the ward” can create enough space for the substantive issue to be discussed.

Where the interaction becomes abusive, threatening or completely unproductive, however, continuing indefinitely is not a virtue. It may be appropriate to end the conversation and return to it later or involve somebody else.

Aggression requires a slightly different response from ordinary disagreement.

The immediate priority is not to demonstrate that you can stand your ground by becoming equally aggressive. It is to maintain clarity, boundaries and safety.

A confrontational colleague may speak loudly, interrupt repeatedly, use intimidating language or attempt to force an immediate answer.

A calm response can be firm without becoming provocative. The behaviour can be named where necessary, particularly if it prevents a productive conversation.

It may, for example, be appropriate to state that you are willing to discuss the issue but not while being shouted at, and that the conversation will need to continue when it can be conducted professionally.

The aim is not to humiliate the other person. It is to establish the conditions under which the conversation can continue.

Persistent aggression, threats, discriminatory behaviour or intimidation should not simply be reframed as a “communication style”. Those behaviours may require formal organisational processes.

Passive-aggressive behaviour can be particularly difficult because the problem is often ambiguous.

Commitments may repeatedly fail to materialise. Important information may arrive late. Agreement may be expressed in meetings but undermined afterwards. Comments can carry an obvious implication while remaining deniable.

The temptation is to confront the label itself.

That is rarely productive. Telling somebody that they are passive-aggressive invites an argument about personality and intention.

The same principle applies as elsewhere: concentrate on observable behaviour and consequences.

Repeatedly documenting missed actions, clarifying responsibilities and following up agreements can gradually remove ambiguity.

Where there is a pattern, the pattern itself can be discussed without speculating about motive.

Feeling undermined is particularly difficult in medicine because professional credibility matters.

Undermining can range from relatively minor disagreement to repeated public criticism, exclusion from relevant communication, disparaging comments or behaviour that damages another person's authority.

Not every challenge is undermining.

A colleague is entitled to disagree with a clinical decision, challenge reasoning or raise legitimate concerns. Healthy teams need this. The distinction lies partly in the manner, pattern and impact of the behaviour.

Where the behaviour is recurrent, it is useful to keep clear examples rather than relying on a general impression.

A private conversation may be sufficient where the colleague is unaware of the impact. More persistent or serious behaviour may need to be addressed through line management or other organisational routes.

A significant proportion of workplace conflict can be resolved informally.

An informal conversation is particularly appropriate when the behaviour is relatively low-level, the relationship is otherwise workable, there is no significant safety concern and both sides have enough psychological safety to discuss the issue directly.

The aim is not to conduct a miniature disciplinary hearing.

It is often simply to reset the relationship, clarify expectations and prevent frustration from hardening into resentment.

Sometimes the most useful outcome is not complete agreement. It may be a clearer understanding of how the two people will work together despite continuing to see the underlying issue differently.

Not every difficult relationship should be solved through better communication.

There are times when escalation is entirely appropriate.

Repeated bullying, discrimination, harassment, threats, serious intimidation or behaviour that places patients at risk cannot simply be treated as an interpersonal problem requiring both sides to compromise.

The same applies when reasonable informal attempts to address repeated behaviour have failed.

The route for escalation will depend on the circumstances and organisation. It might involve a clinical or educational supervisor, line manager, clinical director, HR team, Freedom to Speak Up Guardian or another appropriate senior colleague.

The GMC's Good medical practice guidance on colleagues, culture and safety places clear expectations on medical professionals to treat colleagues with kindness, courtesy and respect and to help create a working environment in which people can ask questions, talk about errors and raise concerns safely.

The important distinction is between escalating because somebody is irritating and escalating because the behaviour has become professionally, organisationally or clinically significant.

This is the point at which a difficult working relationship stops being simply an interpersonal issue.

Incivility can make people reluctant to ask questions. Junior staff may hesitate before contacting a senior colleague known to react badly. Team members may withhold challenge because previous attempts have been dismissed. Important information may not be shared because two people avoid speaking to one another.

At that stage, the quality of the relationship becomes relevant to patient care.

The GMC's guidance on working with colleagues explicitly connects effective multidisciplinary communication, clarity about responsibilities and continuity of care with patient safety. (ISC Medical)

This does not mean every unpleasant interaction represents a patient-safety event. It does mean that clinicians should notice when interpersonal difficulty starts altering professional behaviour.

A junior doctor avoiding escalation because a consultant is intimidating is not simply experiencing a personality clash. A handover that repeatedly fails because two teams refuse to communicate is not merely an uncomfortable relationship.

Once safe working is affected, resolution becomes a professional responsibility rather than a matter of personal preference.

Healthcare remains hierarchical, even though modern multidisciplinary practice is more collaborative than it once was.

Hierarchy can make difficult relationships substantially harder to manage.

It is easier for a consultant to tell a junior doctor that their communication is problematic than for the junior doctor to have the same conversation with the consultant. A manager may control resources or opportunities that affect the person challenging them. A trainee may depend on somebody for supervision or assessment.

Advice that simply tells people to “have an honest conversation” can therefore be unrealistic.

The degree of power difference should influence how the issue is approached. Support from a supervisor, mentor, Freedom to Speak Up Guardian or another senior colleague may be appropriate before a direct conversation. In some situations, direct confrontation may not be the safest or most effective first step.

Good conflict management acknowledges power rather than pretending it does not exist.

Conflict often becomes much more entrenched when one or both parties decide that resolution requires the other person to admit they were wrong. This shifts the conversation away from future working and towards retrospective judgement.

There are situations in which accountability matters and behaviour needs to be formally addressed. Many everyday workplace disputes, however, do not require a verdict.

Two colleagues may continue to disagree about what happened in a meeting and still establish how future meetings will be handled.

A doctor and manager may never agree about whether an earlier decision was reasonable but can still agree on a process for future decisions.

Resolution sometimes involves accepting that the other person will leave with a different interpretation of events. That is not failure. Sometimes it is simply what mature professional relationships require.

Professionalism does not require liking everyone. Some colleagues will never become friends. Personalities may clash, values may differ and communication may never feel particularly easy.

The objective in those circumstances is a functional professional relationship. That relationship needs enough mutual respect to exchange information, challenge safely, make decisions and fulfil responsibilities. It does not require emotional closeness.

This distinction can be surprisingly liberating. Considerable energy is sometimes spent trying to transform a relationship when a more modest objective would be perfectly adequate. Professional cooperation is enough.

Not all conflict should be eliminated.

Teams in which nobody disagrees are not necessarily healthy. Genuine differences in clinical judgement, priorities and experience can improve decision-making when they are expressed constructively. The problem is not disagreement itself.

The problem emerges when disagreement becomes personal, people stop listening, hierarchy suppresses legitimate challenge or relationships deteriorate to the point that communication becomes unsafe.

Effective teams therefore need the ability to disagree without making disagreement relationally destructive. This is particularly important in medicine, where unquestioned consensus can be as problematic as overt conflict.

Most difficult relationships become easier to manage when several principles are applied together.

• First, define the behaviour rather than diagnosing the person. Establish what is actually happening and distinguish what you have observed from what you have inferred.
• Then consider the context. Workload, competing priorities, communication styles, hierarchy and previous history may all be contributing to the interaction.
• Examine your own role with the same degree of seriousness. Small adjustments in timing, tone or framing can sometimes produce a disproportionate improvement.
• Where a conversation is needed, make it specific. Describe the behaviour, explain its impact and be clear about what would help in future. Listen to the response rather than simply waiting for agreement.
• Keep the discussion as close as possible to the practical problem and the shared objective.
• If the behaviour is serious, repeated or beginning to affect patient safety, recognise that the issue has moved beyond ordinary interpersonal conflict and use the appropriate organisational route.

There is no single script that works in every difficult relationship. Effective conflict management depends on judgement, context and proportionality.