By Richard C Senelick, MD, and Elizabeth Bilderback, MA
Editor’s note: This is part 1 of a two-part series
The truth is that difficult people are a part of life. Sometimes it’s our patients or their families and unfortunately, sometimes it’s us. When you catch yourself thinking about “them” and what “they” should be doing to make things easier for you, it would be better to consider what you actually control. You only control you, what you think, perceive and feel. We manage others, but we really can’t “make” others do anything.
You aren’t alone in struggling to cope with these difficult people. If you Google “difficult people,” you’ll get 1,130,000,000 results. Not hundreds, not thousands but billions. Try “difficult physicians” or “difficult patients” and you get millions of results. Just “difficult clients” yields millions. So, the truth is, people are difficult to deal with, some more than others. Some all of the time, and some just part of the time. This is a critical issue in healthcare where stress levels tend to run high, and the pandemic only makes it worse. As healthcare employees, we work on the frontlines of the distressed, overwhelmed and frightened.
Patients and Families
We all know the most common types of difficult people: demanding, complaining, whining, refusing. They may be angry, anxious or controlling. Sometimes it makes you wonder if they even want to be pleasant. The healthcare setting takes away control from patients and families, and that lessened control can lead to intense emotions and unexpected behavior. How we react greatly affects the ultimate outcome for everyone involved. The good news—how we react is exactly what we can control.
In addition, providers are dealing with their own perceptions and expectations of how things “should” be. Remember that we don’t work in a magic bubble. We are coping with our own stress, and the pandemic hasn’t made anything better for anyone. The biggest problem with difficult people arises when we are highly stressed, and then we encounter a highly stressed person with unmet expectations. It is time to talk about people’s expectations and what we can control.
Perceptions and Expectations
Herb Cohen, negotiator and author of “You can Negotiate Anything,” points out that it is always the “how” or emotional content of an encounter that drives the “what” or facts of the event. Have you ever had an encounter at work that raised your blood pressure, so you had steam pouring from your ears? You couldn’t wait to get home and tell someone about your awful day. You drive on the freeway getting even more agitated as you relive the event blow-by-blow. At dinner you pour out the injustice of the events only to have your partner or family give you a pathetic stare and remark, “that doesn’t sound so bad.”
How did that happen? It was your perception of the event and what you “brought to the party” that led to your emotional response, not the actual event. Our beliefs become “our” reality, even when others don’t see it the same way.
The healthcare provider has an expectation of how they “should” be treated by the patient/family and how they “should” behave. The patient and family have similar preconceived beliefs about how the visit or hospital stay “should” go. However, unrealistic or unmet expectations lead to stress, frustration and anger. The less control a person has of the situation the greater potential there is to get angry. The perfect experience is when the person’s expectations are met by their healthcare provider.
What are those unmet expectations? Frankly, most patients want to be the way they were before they were sick or disabled. Most families want the same thing. Some families cope better, maybe because they have better health literacy, but often because they have better coping skills. They have the means, psychologically, socially and financially, to actually manage an illness or disability. But if you want to be the way you were, and you are struggling to manage not being the way you were it becomes rather easy to have unrealistic and therefore unmet expectations. How often have you heard:
- I should have
- I am entitled to
- I should get what I need
- It’s not fair
Right or wrong, you can better deal with this if you understand it. And the above set of beliefs can quickly move to, I didn’t get what I am entitled to because:
- I am not respected
- I am not important enough
- Other people are more important
- They just want my money and take advantage of me
- No one cares
Hold on to these thoughts for in our next installment we will discuss strategies for interacting with difficult people. Watch this space.