Patient communication is trained, rehearsed and structured. Over decades, healthcare has built recognised frameworks for breaking bad news, handling anger and responding to distress, the very skills at the heart of the Maguire model. Clinicians know how to set an agenda, ask open questions and acknowledge emotion before moving to a plan.
Almost nobody is formally taught how to tell a peer they've made an error, or that their tone with junior staff is causing problems. Without a structure, most of us do one of two things: avoid the conversation entirely or voice it badly and make things worse. The problem isn't a lack of communication skills, it's that we've never been given permission or a framework to use those skills on each other.
The relationship doesn't end
A difficult conversation with a patient happens within a defined clinical relationship. A colleague is someone you'll see tomorrow, next week, and for the next few years.
The fear is rarely the conversation itself. It's the imagined aftermath: the awkward silence in the canteen, the worry about being labelled difficult, the possibility of quiet retaliation. When the perceived cost of speaking is ongoing, silence feels like the safer option, even when we know it isn't.
Hierarchy runs in every direction
With a patient, the clinician holds a clear role: it is their job to have the hard conversation, however uncomfortable. Between colleagues, the power dynamics are tangled and often unspoken. Challenging someone senior triggers genuine career anxiety, especially for junior staff. Professional boundaries: nurse to consultant, AHP to surgeon, add another layer. And when everyone is wondering, "Is it really my place to say something?", the usual answer is that nobody says anything at all.
It feels personal
Challenging a colleague feels like a judgment of them, their competence, their character, and their professionalism. We fear being heard as attacking rather than helping, and without care, that's often exactly how it lands.
This is where the skills transfer directly. Acknowledging before challenging. Asking rather than telling. Listening for the cue behind the defensiveness. The same techniques that let clinicians sit with a distressed patient allow a difficult peer conversation to stay a conversation, rather than becoming a confrontation.
Why it matters: avoided conversations are unsafe conversations
It would be easy to file all this under "workplace awkwardness", uncomfortable, but not a priority. The evidence says otherwise. In simulation studies of neonatal intensive care teams, Riskin and colleagues found that exposure to rudeness significantly impaired both diagnostic and procedural performance, and the effect extended to team members who merely witnessed it (Riskin et al., 2015; 2017).
Porath and Erez (2007) demonstrated the same pattern outside healthcare: incivility reduces cognitive performance, creativity and helpfulness even in bystanders.
These findings underpin the Civility Saves Lives campaign, founded by UK emergency medicine consultant Chris Turner, which has brought this evidence to the NHS. Teams where people cannot speak up are teams where risks go unchallenged, a theme that runs through the Francis Report's findings on organisational culture and patient harm (Francis, 2013).
Much of that incivility persists for one simple reason: nobody addresses it. Every avoided conversation is a behaviour quietly endorsed.
The gap isn't skill, it's structure and permission
If you work in cancer care, you almost certainly already have the core skills these conversations require: open questions, active listening, picking up cues, acknowledging emotion, negotiating a shared plan. These are the evidence-based behaviours at the heart of the Maguire model, and as Michael West's work on compassionate leadership shows, attending, understanding, empathising and helping are just as powerful between colleagues as they are with patients (West, 2021). What's usually missing is the confidence to apply them beyond the clinic room and a safe space to practise.
That's exactly what our Maguire Communication and Leadership Academy courses provide. Through facilitated, scenario-based learning, you can rehearse the conversations you've been avoiding, with feedback, without consequences, so that when the real moment comes, you have a structure to lean on rather than a script to invent.
Ready to have the conversation you've been putting off? Explore our upcoming Maguire Communicating with Colleagues Workshop. Your colleagues, and your patients, will feel the difference.
Related resources
References
- Civility Saves Lives (no date) Civility Saves Lives. Available at: https://www.civilitysaveslives.com (Accessed: July 2026).
- Francis, R. (2013) Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. London: The Stationery Office.
- Maguire, P. and Pitceathly, C. (2002) 'Key communication skills and how to acquire them', BMJ, 325(7366), pp. 697–700.
- Porath, C.L. and Erez, A. (2007) 'Does rudeness really matter? The effects of rudeness on task performance and helpfulness', Academy of Management Journal, 50(5), pp. 1181–1197.
- Riskin, A., Erez, A., Foulk, T.A., Kugelman, A., Gover, A., Shoris, I., Riskin, K.S. and Bamberger, P.A. (2015) 'The impact of rudeness on medical team performance: a randomized trial', Pediatrics, 136(3), pp. 487–495.
- Riskin, A., Erez, A., Foulk, T.A., Riskin-Geuz, K.S., Ziv, A., Sela, R., Pessach-Gelblum, L. and Bamberger, P.A. (2017) 'Rudeness and medical team performance', Pediatrics, 139(2), e20162305.
- West, M.A. (2021) Compassionate Leadership: Sustaining Wisdom, Humanity and Presence in Health and Social Care. London: Swirling Leaf Press.