Whether you are a paramedic, nurse, doctor, or an hospital admissions associate, difficult patients can ruin your day.   Hateful remarks or an uncooperative spirit can unravel your nerves and infringe upon your productivity. 

To keep from losing control, it pays to understand why people are difficult.  Your communications skills and personal touch can reverse a bad situation.

These tips are important to know:

·         Difficult people were often manipulated as children.  They cannot read other people or normal situations properly.  They feel they are going to get the worst end of every deal, so to speak.  Communicate well by over-explaining things, if necessary, to reduce fear.

Example:  “Mrs. Myers, I want you to rest assured that we want to answer all of your questions.  We will stabilize your physical symptoms first.  Please don’t think we don’t hear your concerns, but let us take care of your physical needs first.”

·         Difficult people can fear they are going to lose something.  They might lose personal control, precious time, or money.  For instance, if a patient hesitates about tests or scans, he or she might worry the insurance company won’t fully cover it.  Ask a patient, “Are you worried about any aspects of insurance?”  Or, say, “Tell me if something is bothering you.  You can be honest with me.”

Remember that it saves time in the long run to totally “be there” for a difficult patient.  Make good eye contact.  Assure this person with a pat on the shoulder.  Never underestimate the fears and concerns of your patients.  Hospital “phobias” or “doctor phobias” can come into play.

Give the difficult patient a little extra time and attention.  But, do set boundaries if you need to.  Patients who become dramatic or extremely difficult cannot be soothed in one setting.  If a patient starts to act out strange behaviors, put your hand up as if to say, “Stop.”  Say to him or her, “We will discuss your case a little later on.  I will give you some time to relax.  This is all I can do for you at the moment.”

Copyright 2008 Hopson Global Education and Training

Maybe you’re fresh out of paramedic school, and you’ve been instructed to take a new EMT in your department under your wing.  But you’ve got a real problem at hand.  The EMT is making you nervous.  You know that he or she does not have adequate medical skills. 

You know you could report this person, but first, you’d like to talk openly with him or her.  Maybe your co-worker is 99% okay in patient care, but you know there are one or two important areas this person could use some coaching.

Try these communication tactics:

·         Ask if her or she feels comfortable performing a certain task.  This opens a dialogue about your areas of concern.  For instance, you might say, “Do you feel confident about your intubation skills?” 

·         Praise this person’s other skills.  Then, target the problem area.  You might state:  “You are so competent in many, many areas.  But, to be honest, I’ve noticed intubating patients seems stressful for you.”

·         Suggest someone to help.  You might state that a certain co-worker who coached you in the early part of your career might help your co-worker.  Say, for example, “Ronnie is a great coach in this particular area.  I think you should talk to him.”

If your co-worker becomes offended, try a more focused form of honesty.  Say forthrightly, “I have to be totally honest here.  I am worried your medical skills need some improvement in this area.  I’d rather hurt your feelings than not confront you about it.”

Give the other person time to think about what you’ve said.  Don’t go overboard in criticism or apologize for bringing up the issue.  Stay calm and grounded.  If the co-worker avoids both you and the issue, this is your signal to sit down with a supervisor with more authority than you.  Insist that the supervisor confront the employee about the lack of proper skills.

Do you fantasize about applying for circus work?  You’re juggling a lot at work and a lot at home.  Anyone would be amazed at your plate-spinning abilities.  However, how would you manage if a family crisis arose to boot?

An accident, illness, death or divorce can send anyone into a tailspin.  If you’re in a family crisis and you wonder how you’ll manage, try these tips:

• Don’t over-share with the boss.  You might soon need a lot of cooperation from him or her.  But for now, don’t pile on too many details.  If you overwhelm your boss, you’ll start to lose empathy if things go from bad to worse.  State only a few facts at first.
• Alert key clients or associates.  Do call others to say, “I’m having a family emergency at the moment.  May I extend my deadline for getting you the information you needed?”  Or, email others, if you feel this is appropriate.
• Enlist trusted people.  If your son, for example, has been in a motorcycle accident, do ask a nurse on each shift to call you—if something important changes.  Or, ask a co-worker to forward work emails to you, since you’ll probably need to work some from home.
• Risk straining a few people.  Do ask your neighbor to feed your dog or pick up your son from soccer practice.  Call in favors from anyone you can think of.   The goal is to ask a little of many people, rather than overload just a few.  It’s better to strain others a little than to risk overloading yourself to the max.
• Work in focused time slots.  Tell yourself, “I will focus on work for the next 60 minutes.  Then, I’ll pick up the phone to check on my family member.  This focus will keep you sane and balanced in doing your job.  But, it can also keep your from over-worrying.
• Check to see what your company offers.  If your employer offers time off, dependent-care assistance or other resources, make it a point to speak up loudly that you need this.

It’s tough enough for anyone to manage a so-called “friendly” divorce, if there is such an experience.  But, if your divorce is turning into a battleground, it’s good to arm yourself with a supporting cast, a good lawyer, and lots of self-care.  Otherwise, your work can suffer.

These tips can help:

·         Keep work and home separate.  Don’t discuss your divorce too much with co-workers.  Work might now become your place of refuge, so don’t expose too much of your private life.  Gossip can rip through your boundaries, if you let too much dirt fly.

Copyright 2008 Hopson Global Education and Training

When a problem arises in any work setting, it’s often a system that’s at fault—not necessarily a person who intends to slack off on work.  For instance, lots of hospitals have running battles between pharmacy techs and floor nurses. 

Nurses have a need for meds to arrive on time.  Pharmacy techs (IV techs, especially) don’t get the word that meds are needed—until patients are running out.

As an emergency responder, you should openly enlist other workers to devise communication that works.  Get the problem out in the open—such as the need for someone to order supplies or service the ambulances regularly—long before you run out of important meds or tires start to blow out on vehicles on a call.  Use humor and a positive attitude to drive home your points.

These tips can work on inviting creative minds to fix a problem:

·         Use humor directed at yourself first.  You might say, “I know I want to keep glued to CNN when I should have my butt in the chair ordering supplies.  So, since I plead guilty to getting distracted, can the rest of you help? Can we get a system going that will create a better flow?”

·         Ask your supervisor how problems should be delivered.  Ask your supervisor, “Would you rather I share what’s not working face-to-face in a meeting with you?  Or, should I just state it in an email?”

·         Pretend you’re being videotaped.  Always write and speak thoughtfully—as if the whole world will watch you on the six o’clock news.  This way, your questions and/or suggestions won’t be offensive to anyone.

·         Never label a person as “the problem.”  In fact, seldom are individuals to blame when big things go wrong.  It’s usually a system—either lacking or faulty.  No one comes to work saying, “I think I’ll goof off and mess up the work environment today.”  When you blame a person, you inflame and hurt your co-workers.     

It can be tempting to state specifically who or what is driving you nuts, but instead, try to maturely present a problem or system that could use some fine-tuning.  By not being offensive to anyone, you can quietly bring it up until creative minds start to invent solutions.

Copyright 2008 Hopson Global Education and Training

Do you need to speak up about a major problem?  Do you worry your supervisor will think you’re a whiner or inept in carrying out your job role?

Anyone can feel very nervous in squaring off with a supervisor.  But sometimes, it’s important—and even life-saving, if safety issues are at stake—to speak up. 

These tips can help you prepare to share your issues:

·         Never attack people personally.  Always state your need to share a problem, but point out to your supervisor, “I want to help fix the problems, not attack an individual in this.”

This keeps your supervisor from becoming defensive.  After all, if you have an issue with a nurse, doctor, or your EMS partner, your supervisor might feel caught in the squeeze.  Supervisors can start to argue or block out the problem.  Then, you’re really on a limb.

·         State the problems by asking questions.  For instance, say, “I wonder how we might diffuse tension between our department and a certain ER doc?”  Or say, “Could we advise ER nurses to give us more information before they talk to a patient’s family?”

·         Act enthusiastic about inventing solutions.  Never act as if a problem is hopeless.  For example, you might say, “We have this huge problem, but I’ll bet we could all think long and hard and come up with a good solution.”

·         Tell the truth without demeaning someone.  Occasionally, you must name someone as “the problem.”  There’s no way around it.  Use sensitive language, but place the problem clearly on the shoulders of your supervisor—where it belongs.

Let’s say you are a paramedic and you know that an EMT, Paul, is making serious

mistakes here and there.  Paul, understandably, is worried about his wife, who is ill.

You must voice the problem to Elizabeth, your shift supervisor.

You might say, for example, “Elizabeth, I hope you’ll monitor Paul in some fashion.  He can’t help being under personal stress, but he’s making mistakes.  This is not like him to lose focus, but this is too important to ignore.”

Copyright 2008 Hopson Global Education and Training

No worker wants a clash with a supervisor.  Sometimes, though, it’s inevitable.  Issues reach a boiling point, and you have to speak up—or act up—to save your sanity.

Maybe you had to voice a disagreement or name an error a co-worker made.  Suddenly, you’re wearing egg on your face.  Your supervisor is angry or upset while you’re plagued with digging out of the mess.

These tips can help:

·         Use “I” statements.  This helps you “own” your part in the tension.  Say, “I am upset that this tension is on the table.  I wish I could fix it.”

·        Acknowledge when the tension is nobody’s fault.  Oftentimes, a problem really is not a person’s fault.  It’s just that something went wrong with the system, so to speak.   If possible, say to your supervisor, “This issue is really not anyone’s fault.”  This takes off a lot of pressure.

·         Don’t share feelings with co-workers.  When you’re at odds with the boss, you’re walking in a political minefield.  Your friends may try to help you and make things worse.  Your enemies could add fuel to the fire.

·         Talk with friends in other locales.   To rebalance your own emotions, do share your feelings with friends in other cities—away from your work setting.  Ask them to help you look at things objectively.  This way, you won’t carry tension to work every day.  You can diffuse on the phone with those friends.

Once tension is circling your work setting, you can only control your own emotions.  You cannot fix the personal tension of your boss.  You can, however, offer to do anything within your power to fix the problem.  Offer this kind of support only after your boss lets you know his or her tension is cooling down.  Otherwise, a knee-jerk reaction could get you fired.

Copyright 2008 Hopson Global Education and Training

Calming and assisting a stressed-out family in a medical situation is tough.  Different personalities come into play.  While some in the family may act rational and calm, others may demand answers or behave arrogantly.

Remember these tips to manage a group of people:

• Try to set a realistic tone.  While you want to immediately share positive information, you must carve out the true picture.  For example state:  “I believe your family member will do fine during the surgery, but I have to admit that his heart issues are beyond my realm of expertise.”  Never feel compelled to skip stating important facts—just to please family members.

• Remind them that their presence is medicine.  Always thank them for being there.  Bur remember:  family members in crisis can tend to “act up” as a show of support in case the patient dies.  For instance, if a family member hasn’t stayed connected to the family until now, he may demand answers and try to demonstrate involvement—carving out a memory in others’ minds that he or she really went to bat for the patient.  

Don’t get caught up in trying to over explain what’s going on.  And, don’t get caught up in

the family drama.  It’s not your job to fix past family history or rudeness.  Physically

remove yourself, if tension escalates.

• Offer to help them find answers.  Whether it’s a question concerning the patient or where to stay overnight near the hospital, enlist your co-workers or hospital social workers to help gain information.  When people cannot find appropriate information, they feel devalued.   

• Ask a few personal questions to bring comfort.  You might ask their names or ask them how the ordeal is affecting them.  Families in a crisis situation can feel their needs disappear as the patient takes center state.  Asking, “Can I get you something to drink?” or “Are you doing okay?” helps bring a small form of comfort.

Dear Judi: I work long shifts at the firehouse. I feel I can’t bond properly with my kids. Any ideas?

J.K., Indiana

Dear J.K. Use small bits of time to stay connected with your children. Think frequency of contact. For example, one-minute “I miss you” calls are important. Or, on your way home, take 10 minutes to buy your teenager’s favorite ice cream. Do plan longer, special times together, but don’t overlook what you can do in a minute or two for each child.

MONEY (picture of a dollar bill, etc.)

Dear Judi: I read all of these articles about investing money. My husband and I never have a dime left over to save or invest? I’m getting worried about this.

T.C., Tennessee

Dear T.C.: Open a savings account with $25. Get in the habit of adding $10 per week to the account. Add $10 each and every week until you make it a habit. Then, try upping the amount to $15 per week. How can you find the money to save? Make a game out of it. Get the family to cut off lights until your electric bill is down $25 per month. Buy only generic brands of groceries and sodas until you chisel $25 per month off your grocery bill.

Play a game with your family to get the savings account up to $2,500 eventually. Whatever you do, never touch this money. Keep growing it. Your goal should be to add at least $200 every month to your savings. Every family should have at least $10,000 in a savings account for emergencies.

MARRIAGE (picture of a couple)

Dear Judi: My husband and I are arguing all of the time. I’m worried we’re headed for divorce court. When should a couple call it quits?

R.T., Oklahoma

Dear R.T.: Take comfort in the fact that 99% of all couples argue strongly at times. Few among us haven’t thought of calling it quits at one time or another. A good spouse is nothing to throw away, so ask yourself: Is my spouse basically a good, moral person? If so, try to hang in there. Start by diffusing the tension.

Invent solutions yourself and engage your spouse in making the solutions work. For example, one woman I know was raging because her husband wouldn’t help with housework. She finally decided to make it a game. She asked her husband and two children to do two 10-minute chores per day. Sweeping the kitchen is called a 10-minute chore. Cleaning out one bathroom sink is considered to be a 10-minute chore. Their house is now in great shape and nobody’s stressed.

My point: When there is a problem, try your best to invent the solution. Make the solution realistic and do-able. Then, ask your husband to participate. People argue when they can’t imagine solutions. Arguing is really fear set on fire! When explosions occur, ask, “What is my spouse afraid of here?”

Do you think your marriage is supposed to fix a lot of your problems?

If you do, think again.

Marriage should not become a problem-solving factory. It’s way too delicate for that kind of operation. Just look at the divorce rates.

In marriage, there are basically five broad categories whereby problems should be solved by the couple. Those categories include problems with children, sex, money, chores, and how to spend leisure time.

“I’m working with several couples in therapy who do overload their marriages,” says a psychologist friend of ours we’ll call Ted. “Some of the spouses see marriage as a place to dump all of their frustrations and anxiety, hoping their mates will fix the issues. But, no spouse can fix a mate’s personal problems.”

Ted goes on to explain that personal issues — past family problems, issues at one’s place of work, weight problems, or needing to build friendships — belong to the individual.

“Personal problems do not belong to your mate,” Ted insists. “If you come home dumping every personal problem on your spouse, your marriage boat will capsize. You will overload a perfectly good relationship this way.”

Married couples need to have individual friendships and supportive relationships outside of the marriage. This gives each person a “go to” place to dump stress and redirect a lot of tension.

Also, a married couple needs supportive couples to “shore up” the stressful, weak places in the relationship.

For example, an older wife we’ll call Joan had some serious health issues. Joan was a heavy smoker who eventually had a heart attack. She coped reasonably well, but her husband, Ed, did not.

Ed almost had a mental breakdown over worrying about his wife.

“Finally, Ed and I joined a group of couples to do volunteer work,” says Joan. “This built extra strength into our relationship because we could feel the love of other people in our lives. Before we joined this group, Ed and I kind of felt alone in the world. Our marriage was sad and stressful.”

Joan goes on to say that she and Ed now exercise with two of the couples in their group. “We hike, bike, and swim often,” says Joan. “It keeps me wanting to live a healthy lifestyle and avoid smoking.”

Joan says that Ed now has men friends to share his problems with.

“Ed can talk to other people if he’s worried about me, for example,” says Joan. “This outside support takes pressure off our marriage, since Ed used to think of me as his whole world.”

Every marriage needs breathing room to make it work. This means you don’t focus on the marriage every moment.

If you think your spouse can fix everything — from your thinning hair to your need for a new job — you are overloading that relationship.

As an individual, it pays to design a plan for tackling many of your own problems that fall into the “personal” category — from dealing with your bad habits to patching up a relationship with your sister. When you take these personal issues into your marriage, you will cause distance and pain in your relationship.

“My wife tries to dump everything from decorating-the-house problems to family feud problems with her extended family on me,” says a man we’ll call Mike. “I dread to come home. I don’t have the strength to deal with every issue my wife wants to discuss.”

These tips can help get your marriage off overload:

• Act out love constantly. Perform small acts of kindness to nurture your spouse, so he or she will know you desire happiness for him or her.
• Define what you’re not willing to do. For example, you might need to tell your spouse that you can’t fix his or her family feud. Set the boundary that you can listen, but you’re not qualified to offer any advice with those kinds of issues.
• Support your mate in seeking professional advice. For example, if your spouse is troubled about family issues, ask your mate to call a counselor. Large problems call for expert advice.
• Work diligently to acquire supportive friends. Do make it a major goal to find solid friendships for yourself. Help your spouse do the same.

“All marriages have their ups and downs,” says a nurse we’ll call Deborah. “My own marriage has been in serious trouble many times. When I can sit down and chat with a girlfriends over a cup of coffee after work, though, I can gain a new perspective on how to deal with my husband.”

Deborah goes on to say, “All problems in a marriage don’t have to be resolved. Many problems are really minor irritations. Letting off steam with a friend helps the pain subside when you’ve had a huge quarrel with your spouse.

“Every person alive needs someone to take their pain to — and it should not always be your mate,” adds Deborah. “Dumping stress on your mate just weakens the relationship day by day. Sometimes, it pays to have a cooling off period and go back into the relationship like it’s a new, fresh thing.”

We agree wholeheartedly with Deborah. The best way to keep a marriage on a steady course is to always behave as if the love relationship is a “new” thing.

It pays to occasionally toss emotional garbage overboard and not discuss it again. Start fresh and let old pain subside.

None of us should expect our mates to have all of the answers we need. However, this doesn’t mean we can’t ask our mates for an opinion or state a problem to see if he or she is willing to offer productive advice.

But, if we depend too much on our mates to absorb our personal stress, we take all of the pleasure out of being together.

A marriage that becomes too unpleasant is in danger of dissolving.