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Coping with difficult people.

Coping with difficult people

Grappling with "people problems" is the toughest task most managers face. This assignment is a particularly tricky one in the lab, where the atmosphere is charged and the level of stress is high.

Unfortunately, most educational programs for pathologists and medical technologists spend little or no time presenting ways to resolve the people problems that students will encounter as professionals. Laboratory managers and staff technologists alike must continually cope with difficult people, including clients, health care workers in other departments, and each other.

Anyone can be difficult, even you. What brings out your most cantankerous self? Do certain circumstances tend to trigger your ire? Does merely hearing the name or voice of a certain administrator set you off? Or does it take an accumulation of events to light your fuse? Tactics that assist us in dealing with difficult people can also be used to modify our own behavior.

What, exactly, constitutes "coping"? It entails making every interaction with a difficult person as positive as possible. It is not about changing the other person. Coping is basically a matter of accepting people as they are. The behavior you find difficult or unacceptable has apparently served that person well. That aggressive surgeon who harangues your staff and questions every test result might be less successful professionally without having single-mindedly pursued his or her goals. Accepting people for who and what they are is the toughest task for most of us.

Another troublesome aspect of dealing with difficult people is accepting that you don't have to like them and they don't have to like you. For some reason - or for no reason at all - certain people simply may not like you. Yet some of us spend an inordinate amount of time and energy trying to win them over. Clinicians, for example, are not necessarily people oriented. Being liked is not their priority. Physicians are more concerned with obtaining timely and accurate test results than in being everyone's friend. Perhaps that's the way it should be.

Consider these four basic strategies for confronting difficult behavior:

1. Put physical or psychological distance between yourself and the difficult person.

2. Stop wishing this person will change; get rid of your "shoulds."

3. Tap a different part of your personality.

4. Try matching energy.

These will be described in turn. * Distance. To utilize physical distance as a short-term strategy, limit the time you spend with an especially difficult person. Often we make ourselves too available. Try saying, "Doctor, I know you're busy. We are, too. I will call you in 10 minutes with that result." Speak firmly and quickly. Matching the other person's energy level is often effective.

We can also use physical distance in setting up our schedule. Some lab supervisors sign up for evenings or nights to avoid a disliked boss or coworker. One teaching hospital solved its prima donna problem by placing a highly valued but decidedly difficult technologist in his own glass cage, creating a sort of private work area. Isolating this temperamental worker kept his expertise in the lab without driving the rest of the staff away. If your first reaction is that a work environment shouldn't have to be set up around one person in that way, check the section below on eliminating the "shoulds" - including the hope that someone will change. * Psychological distance. Among the most effective short-term strategies, psychological distance allows us to see a person or event from a new perspective.

A pediatric outpatient clinic at a large St. Paul teaching hospital used this approach brilliantly, devising a strategy I have come to think of as "code orange." A particularly persnickety pediatrician who worked at the clinic was prone to public temper tantrums whenever he had to wait for an examining room. He would scream at the staff and then yank the phone off the wall and throw it. Patients and their parents were understandably upset, and so were the other physicians and health care workers. Counseling efforts were futile.

What worked? A savvy clerk's guerrilla warfare. The next time this cranky clinician commenced his tantrum, she announced "Code Orange, Code Orange" over the clinic's public address sytem. Every staff member at the front desk, alerted to her ploy in advance, responded to the "code" by rushing over and surrounding the explosive physician. They watched his performance intently and then went about their business.

Four days later, the physician was at it again. This time, the entire clerical and nursing staffs answered the call, standing silently in a circle until the tantrum had subsided. They repeated this version twice more. The next time, the other staff physicians joined the drill. Their support did the trick. Embarrassed by his colleagues' attention, the peevish pediatrician stopped acting like a pediatric patient himself and has behaved himself ever since. The strategy succeeded because the staff made his rantings and ravings an official "emergency."

The code orange tactic can be applied in any number of ways. For example, the next time you face an unreasonable colleague, ask yourself whether this is a code orange situation. You may want to share this wisdom with others. I know of one surgery unit in which the nurses give each other a wink whenever a certain surgeon acts up. This wink stands for "code orange." Instead of getting upset and uptight over something they cannot control, the nurses share a secret wink. This conspiratorial action creates the needed psychological distance.

Yes, it is a shame to have to play childish games with fellow professionals. The offenders should simply get their acts together. But most won't; and so, to retain our sanity, we must. * Lose the 'shoulds.' Do these complaints sound familiar?: "I shouldn't have to put up with this." "They should do something about that person." "He shouldn't treat me that way." We all spend too much time wishing. that people's personalities would change. This woolgathering tends to lead to the fantasy world of "shoulds" - a journey we must not allow ourselves to take.

It is not easy to relinquish our "shoulds." Doing so means releasing some of our most cherished beliefs about people . . . that they will improve, that they will suddenly do the right thing, treat us with more consideration. I find that it helps to poke fun at my "shoulds": "No, Ken, he should not have talked to you that way. But he did." Try sometimes to laugh at your "shoulds."

Despite all my own sage advice, I find myself unwilling to release certain "shoulds," which I call "resistant shoulds." In such cases, I find it helps to ask myself what will happen if I persist in hanging onto these "shoulds." The answer is usually more stress for me and virtually no disturbance for the other person.

Another coping mechanism is to acknowledge that the other person is doing the best he or she can at that particular moment. This means suspending judgment and allowing for the possibility that illness, a fight with a spouse, trouble with a teenager, or any other outside concern can temporarily hamper a person's performance at work. * Tap your personality facets. Different difficult people respond to different interpersonal styles. It is possible to draw on various personality traits to accommodate them. This approach, developed from Eric Berne's transactional analysis (TA) theory, identifies six parts of the personality, listed in Figure I. These will be discussed here in some detail. [P] Critical parent. This persona would be appropriate in a lab when, for example, a technologist failed to follow proper procedures or methods: "I don't ever want to see you do that again." When assumed inappropriately, the critical parent persona blames or ridicules other: "Can't you do anything right?" [P] Nurturing parent. This personality type reflects the altruism of health care professionals. The nurturing parent strives to see things from the other person's point of view. Overuse breeds insecurity and dependence, setting up the offender as Big Mama or Big Daddy. Instead of thinking for themselves, staff members keep asking the overnurturing supervisor for unnecessary guidance. In this case, a supervisor must switch to the adult persona and ask staffers how they think the procedure should be done. [P] Adult. The adult personality calmly provides facts, figures, and other data, usually in an unemotional monotone. Practitioners sound like Joe Friday from the old Dragnet television series: "Just the facts, ma'am." Overuse of this persona may make others feel dehumanized. A laboratory employee whose quick thinking has averted a major accident deserves a nurturing parent pat on the back rather than a snippy "Make sure that never happens again!" [P] Free child. With this persona our sence of humor resides. In the stressful laboratory environment, an occasional dose of free child helps release tension. But inappropriate use comes across as flippant or callous. Note: The free child approach will not work with know-it-alls, who take themselves and their work very seriously. [P]

Complaint child. This adaptive personality tries to please everyone. This tactic can be helpful when dealing with doctors: "We'll get that test done whenever you want it." The promise is easy to make because the compliant child in the lab knows the next shift will have to deliver or face an irate clinician. That's the down side. If we overuse the complaint child approach, we will inevitably make promises that cannot be kept. A chameleon runs the risk of losing his or her identify and, over time, respect from others. [P] Rebel child. This personality trait comes out in a get-even, "I'll show you" attitude. The rebel child, frequently called upon to answer a critical parent, thinks, "I'll fix her!" or "If she thinks turnaround is slow now, just wait until tomorrow." Is the rebel child persona ever appropriate? It is certainly well enshrined in American history; consider Paul Revere's ride, the Boston Tea Party, and Vietnam War protests of the Sixties. Recent developments in Eastern Europe attest to the power of the rebel child.

Everyone in the lab field has surely seen rebel child resistance to ill-considered critical parent stands on pay, workload, and scheduling. When used inappropriately, the rebel child persona lashes out to retaliate for a presumed slight or attack: "You didn't ask for that test. Do you think we're mind readers? I'll get to it when I can, but you'll have to wait." A preponderance of rebel children in a lab suggests a management style heavily favoring the critical parent approach. * Choose your persona well. We naturally tend to let the critical parent within us respond. It comfortably places responsibility elsewhere and makes us feel better: "If nursing would fill out lab slips properly, there wouldn't be any problems." When another takes the critical parent stance, it serves no purpose to respond in kind. Instead, tap the adult, nurturing parent, or free child within you. An adult response might be: "The lab slips say it takes three days to complete this test. You requested the procedure 24 hours ago." A nurturing parent, observing the situation from the nurse's viewpoint, might comment: "You must be under a lot of pressure, since Dr. Smith wants those results right away." A response in the free child mode: "You're right. Only an idiot would work in a lab as long as I have."

We can choose to respond to others by using any single part of our personality or a combination of its components. In general, the safest course is to favor the adult aspect, with its absence of emotional baggage. The nurturing parent and free child can be assets in emotionally charged situations. For lab managers, it is best to avoid the critical parent routine except in a crisis or when dealing with a safety concern. * Use matching energy. There is a law of interpersonal communication called the law of matching energy. The idea is to match the other person's energy level in mannerisms and the speed, pitch, and volume of the voice but not in the verbal message. This approach indicates that you appreciate the importance and urgency of the message. An example:

A physician tells a nurse to call the lab for a test result. She does so and is told that the lab will send the result soon over the computer. Ten minutes go by; the nurse calls again. This time she is direct and speaks in a rushed voice: "Where are those test results? Dr. Simon has been waiting more than an hour." The technologist explains slowly and calmly that the computer is down. His reserved demeanor sends an unintentional signal that the lab is uninvolved and unconcerned. A slightly less laid-back response would have displayed an understanding of the urgency of her request - despite an identical inability to grant it. * Choice is power. Among the many options for improving communication with difficult people are to establish physical and psychological distance, release your "shoulds," tap different parts of your personality, and match energy levels to indicate awareness and empathy. Training and practice can help laboratorians learn to deal with all types of difficult people and minimize one important source of stress in the workplace.

The author is president of Communications Management Group, Houston, which provides health care training and development programs, and adjunct professor at the University of Houston. He is in the human resource development department at Methodist Hospital, Houston, and has taught communication and group dynamics in the medical technology program, University of Colorado, Denver.

PHOTO : Figure I

Elements of your personality to choose from when coping with difficult people

Critical parent Protective; represents rules, procedures, regulations, values;

offers safety in crisis

Nurturing parent Supportive, war, helps others
Adult Computer-like; full of information, facts, and figures;
 unemotional; speaks in a monotone
Free child Creative, humorous, playful

Compliant child Adapts to others' expectations; tries to please

Rebel child Retaliates whenever possible
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Title Annotation:part 1
Author:Nations, Kenneth H., III
Publication:Medical Laboratory Observer
Date:Sep 1, 1990
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