By Richard C Senelick, MD, and Elizabeth Bilderback, MA
Editor’s note: This is part 2 of a two part series. Click here to read the first part.
You would think that once you understand these beliefs and attitudes that you, a well-trained professional, could easily respond and deal appropriately with them. But wait, it can be a collision course! We bring our own set of beliefs to the party and if we don’t understand them, we are headed for trouble. Be honest and ask yourself how often you have caught yourself thinking:
- They don’t appreciate what I do.
- I try to be perfect and so should everyone else.
- I’m the professional here; I know best.
But the good news is that you can control your more irrational beliefs by finding the underlying thoughts, and do what psychology calls “reframing.” First change your thoughts, and as you do this repetitively, you will find your beliefs become more realistic. Then it becomes so much easier to focus on our patients’ and families’ belief systems and manage them. Notice the word is “manage” not “control.” It helps to ask every patient what they expect from the hospital stay or from your therapy. Remember this is actually different from setting goals with a patient, although it is clearly part of the same conversation. It also helps to clearly ask what the family expects. This is the time for active listening time, not an opportunity for you to tell someone what is going to happen. Seek first to understand.
Most of us are not particularly good at listening. We tend to interrupt and direct the conversation where we want it to go. The first order of business in dealing with difficult people is:
- Find a quiet place with no distractions.
- Focus on understanding the other person’s point of view.
- Ask yourself, what did the person or you expect during that visit or hospitalization.
- Ask yourself, “Are these expectations realistic given the circumstances of the event?”
- Don’t take it personally or be defensive.
In 2013, Aileen Pascual, MD, published a slide share on “Dealing with Difficult Patients.” In it she lists a terrific, straight forward strategy to “Take Heart” and deal with these difficult people.
- Hear them out: This is the active listening part.
- Empathize: Put yourself in their shoes. How would you feel? How does this injury/illness disrupt their life— not just medically?
- Acknowledge/Apologize: Express understanding of what was said. Ask for clarification. Make amends as needed and use blameless apologies.
- Respond appropriately: Gently and carefully provide more realistic expectations, but never take away hope.
- Take responsibility: For your thoughtlessness, for not understanding, for the medical system having limitations.
- Thank the patient or family for being patient: Recognize that being in this situation is challenging and it can bring out the worst in all of us.
We don’t learn these things in medical, nursing or therapy school. However, with time and practice you will get good at it and find that you are no longer anxious or stressed when you are faced with difficult people.