This research examines the experiences of Malaysian Neurosurgeons in managing communications with patients and their families in the aftermath of adverse medical events. These experiences were interpreted from a conflict avoidance and management perspective and the data from the research was analyzed using heuristic methodology. (Douglass and Moustakas 1985) The field of Neurosurgery in Malaysia was chosen firstly as a model of a high-risk medical specialty and secondly because of the researcher’s lived experience with the phenomenon being studied. Participants in the research were eleven Malaysian Neurosurgeons with at least ten years of independent clinical practice as specialists. Qualitative data was obtained through semi-structured in-depth interviews that were subsequently transcribed and analyzed heuristically, looking for different conflict management and patient-physician communication themes. The observations indicate that adverse medical events precipitate a major shift in the focus of tacit conflict management skill sets applied by the participants. The patient-Neurosurgeon relationship is abruptly transformed from one of high trust to one imbued with patient anxiety and suspicion of malpractice or medical error, and physician defensiveness. The observations also indicate that in multicultural Malaysia physician-family relationships were prioritized more than would be expected in a Western context. This may have implications for humanistic and interactive skills training for medical students and residents.