There is so much we don't know in medicine that could make a difference,
and often we focus on the big things, and the little things get forgotten. To
highlight some smaller but important issues, we've put together a series of
pearls that the Red Whale found at the bottom of the ocean of knowledge!
Assertiveness: win friends and influence people!
“The meek will inherit the earth – if that’s alright with the rest of you?” – The Meek
What is assertiveness?
Assertiveness is:
The ability to express emotions and feelings.
The ability to express opinions, thoughts and beliefs (even if they contradict others and it is difficult to do).
The ability to stand up for yourself without being abusive or aggressive.
Finding a way to do this is the ‘holy grail’ of communication.
All of us can give countless examples in general practice of colleagues who are:
Aggressive and rude (yet consider themselves ‘strong minded’).
Passive and ineffective (who consider themselves ‘people people’).
Assertiveness is a key aspect of emotional intelligence and like any skill can be learnt.
The goal is not to produce robots that are able to trot out trite phrases (much like Daleks with stethoscopes, not-so-subtly
concealing their pent up fury – “we will communicate”!!!!!).
Rather, we aim to make it work for your own style of communication, be it with humour, directness or softness.
Does it matter?
In a word, yes! The ability to communicate in an assertive manner results in:
Win–win conversations.
Staff who are less stressed.
Staff who are happier in their jobs.
Staff who are more productive.
People who are more assertive are less stressed themselves, have the ability to solve problems better and win friends and influence
people.
As senior leaders only too often demonstrate, winning an argument, either through evoking hierarchy, being ‘cleverer’ at debating, or
by plain old ‘shouting louder than anyone else’, rarely makes the other person love you.
“The more arguments you win, the fewer friends you’ll have” – Ancient Proverb
Aggressiveness vs. assertiveness
Much of the confusion about assertiveness lies in the fact that so-called ‘assertive’ people often display behaviours that belong firmly
in the ‘aggressive’ category. And for you passive–aggressive people out there, just because you are not shouting, doesn’t mean that
you are not being aggressive!
Assertive people
Have the self-awareness to recognise their own feelings
Have good emotional regulation and impulse control
Are able to stand up for their own rights
Respect the points of view of others
Are sensitive to the needs of others
Aggressive people
Do not recognise the feelings of others
Need to get their own way regardless of the
consequences
Do not respect the rights of others
Do not respect the views of others
Force others to acquiesce and display ‘bullying’ behaviour
How to communicate assertively
Here is a model you could try – you will notice as you read on in the handbook that this is very similar to the model recommended for
having ‘difficult conversations’ – become skilled at one and you will develop skills for the other.
When you need to be assertive:
Now let’s look at an example of dealing with a common practice-based problem in three different ways:
An assertive example
“I have an important meeting next Friday lunchtime; I should be there as I have done a lot of work on the cancer pathway.
Unfortunately I am supposed to be Duty Doctor that morning” (state the problem).
“I really need to be able to leave by 12pm to get to the meeting and I am worried that I won’t be there on time. I’d be very grateful if
someone else could cover” (state your needs and feelings).
“I understand that the practice is quite short-staffed on a Friday, patients are already booked in and this will cause some
inconvenience and extra work for reception” (use empathy).
“If I am not at the meeting, our practice won’t be represented in some important negotiations” (communicate the impact).
“How about if I cover the duty slot until 11am and then ask someone else to cover from then? I can see a couple of extras at 11,
and I would be happy to do this for someone else if this arises again in the future” (suggest a possible solution).
“How does that sit with you?” / “Do you think that would be possible?” (give them a chance to respond and discuss).
An aggressive example
“I’ve just noticed that I’m rostered on as Duty Doctor on Friday. I told you in plenty of time that I have a meeting at lunchtime”
(blaming and shaming).
“This is really annoying and now someone’s going to have to cover for me. I have to be at this meeting you know otherwise we’ll
lose money – there could be redundancies” (scaring tactics).
“You’ll just have to find someone to do it for me” (bullying).
“Now I’m late for Mrs Brown’s ingrowing toenail” (not taking responsibility for own actions). “Just what I don’t need today...”.
(Practice Manager crawls into cupboard and *takes a long sip of gin / cries until he can cry no more / sticks pins into effigy of said
doctor / secretly determines to put said doctor on duty on a Friday until Kingdom Come *delete as applicable).
A passive and ineffective example (a.k.a. wet doormat)
“Um – excuse me, sorry to trouble you, it’s just that I’ve noticed that I seem to be on duty on Friday morning – probably my
mistake” (taking too much responsibility for another’s actions).
“It’s not really very convenient, just that I was hoping to… what’s that? Oh, Dr Davies has an important dinner party to get to in the
evening so she can’t cover. OK, it’s just that… oh sorry that you missed the email about the meeting” (thinly disguised blame).
“Again, probably my fault. No, I don’t want to bother Dr Davies about it; it’s probably OK” (failure to acknowledge own fee lings).
“I might be a bit late but I’m sure they’ll understand” (not understanding own rights or needs).
“I tell you what; I’ll just take my phone to the meeting. What’s the worst that can happen?”.
(Doctor goes back to room and *disappears into a puddle / feels sorry for himself and consumes a 100g bar of Green and Blacks /
is a bit short with the next patient then overprescribes to compensate for being slightly narky / adds this to his long list of ‘ways that
the practice has wronged me’ and seethes with resentment before eventually resigning over a very minor rota error *delete as
applicable).
Some other useful strategies
Scripting
Work out what you’d like to say in advance.
Practise it!
Allow others to take responsibility for their own actions and feelings
You can only control yourself (see below).
Control yourself
Allow yourself to express negative emotions and anger but only in a respectful way.
Always take account of other people’s feelings – remember that PEOPLE MATTER – they also, like elephants,
have a very long memory!
Buy yourself some time
Not all conversations and requests need an immediate response.
If possible, ask the person if you can get back to them when you’ve had a chance to think about it / check your
diary.
Learn how to say ‘no’ – say ‘yes’ to the person and ‘no’ to the task
This involves saying ‘no’ to what you are immediately being asked to do but saying ’yes’ to the individual by
aiming to fully understand their needs, continuing to express concern that their needs are met, and offering
solutions where possible.
Recognise where that person is coming from, what their needs are (e.g. receptionist asks you to do a medical
report urgently – patient at the desk is getting very aggressive and wants it right now). Use empathy.
Work out if you should be doing the task or not (see box below).
Explain why you can’t help at the present time, despite really wanting to be of service to them.
Suggest an alternative plan: perhaps you could phone the patient later in the day when you have more time to
explain why the very long and complex medical report can’t be done in 5 minutes?
How to work out if you're the right person for the task
Ask yourself:
Do I have time to do it?
Use the urgent / important matrix if necessary (see ‘Time management’ article)
Am I the right person to do it?
Is someone else better suited to the task?
Does the task fit with my own personal agenda?
Taking into account your professional responsibilities and job contract!
*If the answer to any of the above is ‘no’ then you may not be the right person for the task.
*Refusing to do a task because you just don’t want to, it is unpleasant, smelly or complicated could be seen as unprofessional!
If your needs are still not being met
Use facts and objective evidence to back yourself up – its very hard to:
ignore someone who is being entirely objective
to argue for an ‘unfair’ solution.
Explain what actions you might have to take if your needs are not met:
be reasonable; explain the consequences of this and then the actions you might need to take as the result of
these consequences.
Assertiveness: win friends and influence people
People matter. The ability to communicate your own feelings and needs whilst taking into
account the feelings of others is key.
Assertive people are not aggressive. They are able to have win–win conversations, solve
problems and take responsibility for their own actions.
Assertiveness is a skill which can be learnt and improved through practice.
Keep an ‘assertiveness diary’
Over the next week, write down all instances when you were (a) assertive, (b) aggressive, and
(c) passive.
What were you thinking and feeling each time?
Why did you feel that way?
What assumptions were you making about yourself, the situation or the other person?
What alternative explanations could there be?
How did the other person react?
How could you have dealt with things differently?
Practice being assertive:
Try the small stuff first. For example:
Send your food back in a restaurant if it is cold.
Ask a colleague to make you a cup of tea.
Say no to buying a raffle ticket.
Complete an emotional intelligence inventory to assess your own strengths in the
assertiveness realm.
Consider further training in assertiveness, for example, an online course or workshop.
The MindTools website has several very useful articles about communication and
assertiveness:
Learn more about saying ‘yes’ to the person and ‘no’ to the task here:
www.mindtools.com/pages/article/newCS_92.htm
We make every effort to ensure the information in these pages is accurate and correct at the date of
publication, but it is of necessity of a brief and general nature, and this should not replace your own good
clinical judgement, or be regarded as a substitute for taking professional advice in appropriate circumstances.
In particular check drug doses, side effects and interactions with the British National Formulary. Save insofar as
any such liability cannot be excluded at law, we do not accept any liability for loss of any type caused by
reliance on the information in these pages.
GP Update Limited
December 2016
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