Authored by Ghazal Adibi OMS-II and Ariela Marshall MD on behalf of the AMWA Gender Equity Task Force


Source: Upstate Medical University

Careers in healthcare can be very high stakes, and a physician’s ability to navigate difficult conversations isn’t just a soft skill—it’s a critical professional competency. For women in medicine, this challenge is often magnified and further complicated by persistent gender bias and systemic barriers to equity.

Research published in JAMA reveals that during residency teaching conferences, female physicians are interrupted significantly more often by both residents and attending physicians compared to their male counterparts (Jagsi et al. 2021). This isn’t just about communication—it’s about respect and professional recognition.

Psychological Foundations of Difficult Dialogues

Dr. Jennifer Morse’s groundbreaking work in “Physician Communication” highlights three key psychological barriers women in medicine frequently encounter:

  1. Gendered Expectations: Societal norms often position women as “caretakers” while simultaneously penalizing them for being too empathetic or “emotional”
  2. Hierarchical Pressures: Medical environments with rigid power structures can make challenging conversations particularly fraught, especially for women, who often face implicit biases, stereotypes, and a lack of representation in leadership positions. These factors can amplify the difficulty of asserting themselves or challenging authority compared to their male counterparts. Women may fear speaking up due to concerns about being dismissed or penalized, and when they do assert themselves, they are often unfairly perceived as too bossy or aggressive.
  3. Intersectional Challenges: Women of color face compounded communication barriers

Strategic Approaches to Challenging Conversations

The CRYSTAL Framework

Drawing from research in conflict resolution, I propose the CRYSTAL approach, which integrates evidence-based practices for managing interprofessional conflicts in clinical settings:

  • Confirm your professional credibility: professional credibility is a source of legitimacy that, when combined with leadership capability, “creates respect and trust by peers and engagement with followers.” (Turner, 2018) This is particularly crucial in healthcare settings, where leaders must navigate complex intersections of clinical logics and decision-making processes.
  • Remain calm and centered – Emotions mediate behavioral responses, including the likelihood of conflict resolution. In conflict resolution, remaining calm and centered can help reduce emotional intensity, fostering a better environment for understanding others’ perspectives and finding solutions (Aureli et al. 2000)
  • Yield space for others’ perspectives: Yielding space for others’ perspectives is essential in conflict resolution because it allows for the inclusion of diverse viewpoints, ensuring a more comprehensive understanding of the issue at hand. Just as feminist interventions in conflict resolution challenge the exclusion of women and reframe key concepts like power, peace, and violence, yielding space for others’ perspectives broadens the dialogue, fostering mutual respect and cooperation. (Sharoni, 2017)
  • Speak with precision and clarity: skilled communication can alleviate patient and caregiver anxiety and reduce provider burnout by improving comfort in handling emotionally charged situations (Littell et al. 2019). This is true for conversations between provider and patients, as well as between colleagues.
  • Acknowledge underlying emotions Emotions such as anxiety, frustration, and empathy can influence the quality of communication and collaboration within healthcare teams. For instance, clinicians often experience anxiety and frustration during challenging conversations, which can affect their ability to deliver care effectively (Martin et al. 2015). Acknowledging whatever feelings may arise whether within yourself or the person who you are having a difficult conversation with, can help you both become grounded and work towards a productive solution.
  • Listen actively and deeply – critical care teams improved their interactions by developing a mindset of humility and inquiry, which was facilitated by understanding each other’s goals and perspectives through active listening. This type of listening helps clinicians understand each other’s perspectives and goals, thereby reducing the likelihood of conflict escalation (Rock et al. 2023).

Let me provide a practical example of what this may look like:

Scenario: While presenting a case during morning rounds, a colleague interrupts you and challenges your diagnosis and approach to management.

CRYSTAL Method Applied:

  1. Confirm professional credibility
  • Before responding, take a moment to ground yourself in your clinical expertise. Imposter syndrome can make this challenging, but remind yourself of the education, dedication, and hard work that have prepared you to be in this position.
  • Quickly recall the 1-2 specific details of the patient’s case and your diagnostic reasoning
  • Example: “Based on the patient’s comprehensive lab results and my detailed review…”
  1. Remain calm and centered
  • Maintain neutral body language. Take slow, steady breaths to keep your movements and demeanor composed. This will not only help you regulate feelings of overwhelm, but also convey a professional and composed body language to others.
  • Avoid defensive posturing or language.
  1. Yield space for others’ perspectives
  • Listen fully to the critique, and show you’re hearing their concerns
  • Even when being interrupted, it’s important to remember that healthcare is a team sport. Consider your colleagues’ perspective, but also remain grounded in your own knowledge and abilities.
  • “I appreciate you bringing up alternative considerations. Let me walk through my clinical reasoning.”
  1. Speak with precision and clarity
  • Reference exact clinical evidence
  • Provide a structured, logical explanation of your diagnostic approach
  1. Take strategic pauses
  • Allow your words to have weight! Don’t be afraid to take up space
  • Give colleagues time to process your explanation
  • Remember that silence can be a powerful communication tool
  1. Acknowledge underlying emotions
  • If tension is evident, address it professionally
  • “I sense we have different perspectives on this case. My goal is to ensure the best patient outcome, and I am sure yours is as well.”
  1. Listen actively and deeply
  • Demonstrate openness to collaborative problem-solving
  • Ask clarifying questions
  • “Could you expand on your perspective about this treatment approach? I want to make sure I understand fully.”

When to Hold Firm, When to Adapt

Obviously, the last example involves a patient case, in which it becomes the physician’s job to advocate for the patient’s best interest. However, in some cases, you might decide that it’s a battle not worth fighting.

Red Flags: When to Escalate

  • Persistent dismissive behavior
    • Consistently belittling or ignoring contributions, undermining professional credibility.
  • Systematic undermining
    • Ongoing actions that prevent female physicians or otherwise underrepresented physician populations from gaining visibility, recognition, or advancement, often by taking credit for their work or sidelining their contributions.
  • Violations of professional ethics
    • Actions that violate fairness, respect, and equality, such as inappropriate comments, sexual harassment, or discriminatory treatment, affecting career progression and personal dignity.

How to Escalate

  • Become familiar with your workplace resources
    • Most institutions provide some form of confidential reporting systems that provide a space for reporting intimidating behavior without fear of retaliation. Know the steps for utilizing these resources and ensure you understand the confidentiality measures in place to protect you. This knowledge empowers you to take action should an escalating conflict arise.
  • Speak with a supervisor
    • Consulting with a supervisor could include your clerkship director, the dean of student affairs for medical students, the program director for residents and fellows, or the division or department chair for attending physicians.
  • Find avenues for support
    • It can be difficult to advocate for yourself, and can even feel isolating at times. It is important to cultivate a support system both inside and outside of your workplace. Seek guidance from trusted colleagues, mentors, or professional support groups who can provide perspective, advice, and validation
  • Document the conflict
    • Accurate documentation helps to ensure that your concerns are taken seriously and not undermined. It can also protect you if the situation leads to formal investigation or reporting.

Remember: Navigating difficult conversations is a skill. Like any skill in medicine, it requires:

  • Continuous learning
  • Practice
  • Self-reflection
  • Compassion for yourself

In a profession where communication can literally save lives, your voice matters. These strategies aren’t about aggression—they’re about creating space for collaborative, respectful dialogue. Your expertise, empathy, and professional integrity are your greatest assets. The skills used to advocate for your patients are the same skills that can be used to advocate for yourself and your loved ones going forward.

Recommended Resources

  1. Crucial Conversations: Tools for Talking When Stakes Are High by Patterson et al.
  2. Medical Professional Communication by Dr. Elena Rodriguez
  3. American Medical Women’s Association communication workshops
  4.  Women Surgeons’ Experiences of Interprofessional Workplace Conflict by Dossett LA et al.

References

Aureli, F., Smucny, D., Cheney, D. L., Seyfarth, R. M., Weaver, A. C., & de Waal, F. B. M. (2000). The     role of emotion in conflict and conflict resolution. In Natural conflict resolution (Chapter 10). University of California Press. https://doi.org/10.1525/9780520924932-015

Jagsi, R., Imm, K. F., Ghaferi, A. A., et al. (2021). Gender differences in interruptions by residents and faculty discussants during residency teaching conferences. JAMA Network Open, 4(1), e2038400. https://doi.org/10.1001/jamanetworkopen.2020.38400

Littell, R. D., Kumar, A., Einstein, M. H., Karam, A., & Bevis, K. (2019). Advanced communication: A critical component of high-quality gynecologic cancer care: A Society of Gynecologic Oncology evidence-based review and guide. Gynecologic Oncology, 155(1), 161–169. https://doi.org/10.1016/j.ygyno.2019.07.026

Martin, E. B., Mazzola, N. M., Brandano, J., et al. (2015). Clinicians’ recognition and management of emotions during difficult healthcare conversations. Patient Education and Counseling, 98(10), 1248–1254. https://doi.org/10.1016/j.pec.2015.07.031

Rock, L. K., Morse, K. J., Eppich, W., & Rudolph, J. W. (2023). Transforming team culture: A case study from critical care. Chest, 163(6), 1448–1457. https://doi.org/10.1016/j.chest.2022.12.046

Sharoni, S. (2017). Conflict resolution: Feminist perspectives. In Oxford research encyclopedia of politics. Oxford University Press. https://doi.org/10.1093/acrefore/9780190846626.013.130

Turner, P. (2018). The importance of professional credibility. In Leadership in healthcare (pp. 173–202).

About the Authors

Ghazal Adibi is a second-year medical student at Ohio University’s Heritage College of Osteopathic Medicine (OUHCOM). She received her Bachelor’s degree in Psychology from Case Western Reserve University. Ghazal serves as President of the Medical Student Pride Alliance at OUHCOM, leading efforts to support LGBTQ+ inclusivity within the medical community. She is also a member of the Rural and Urban Scholars Pathways program, Future Leaders Council of Academy of Medicine Cleveland and Northern Ohio, and the American Medical Women’s Association. She currently volunteers with the National Alliance on Mental Illness, where she is training as a helpline counselor to support individuals experiencing mental health crises. Ghazal’s ongoing research focuses on LGBTQ+ medical students’ experiences during clinical training and diabetes management in LGBTQ+ patient populations, aiming to improve healthcare outcomes and patient-provider relationships in underserved communities. An aspiring psychiatrist, Ghazal is passionate about addressing mood disorders, personality disorders, and the mental health challenges faced by healthcare professionals. She is deeply committed to advocating for improved mental healthcare access and reducing stigma among minority populations. She is inspired by her own experiences as an immigrant from Iran, motivated to end the stigma on mental health and increase access to mental health care.

Dr. Ariela Marshall is a Harvard-trained physician and an internationally renowned advocate, career development advisor, and mentor. Dr. Marshall specializes in bleeding and clotting disorders, especially as they relate to women’s health. She has worked at Mayo Clinic and the University of Pennsylvania and currently practices part-time as a consultative hematologist at the University of Minnesota. In addition to her clinical work, Dr. Marshall is a highly respected leader, mentor, and speaker. She is an active leader with the American Society of Hematology (where she led efforts to found the Women in Hematology Working Group and currently holds seats on the Women in Heme Working Group, Committee on Communications and Media Experts Subcommittee) and American Medical Women’s Association (leading the Infertility Working Group and holding seats on the Gender Equity Task Force). She is the Chief Innovation Officer at Women in Medicine and the Curriculum Chair at IGNITEMed, which are both 501(c)(3) nonprofit organizations dedicated to promoting career development for women in medicine. She speaks regularly on a national and international scope to discuss her efforts to advance career development and mentorship for physicians, gender equity, fertility/infertility awareness, parental health and wellbeing, reproductive health and rights, and work-life integration.

Formatting, publication management, and editorial support for the AMWA GETF Blog by Vaishnavi J. Patel