Sometimes you learn things in unexpected places. You may gain great wisdom just by heating up your food in the lunch room – at least I have. One of the best pieces of advice I’ve ever heard was garnered while I was using the microwave as two colleagues had a conversation near me. One was explaining that when she was a new nurse she would go home and complain to her mother about work.
“I’d say, ‘So-and-so did this, and this person said that, and it made me really mad,'” she recounted. “And my mom would ask, ‘Well, did you tell them you were upset?”
Her response, like many of ours would be, was “No.”
And here is where the wisdom I so fortunately eavesdropped on comes in: Her mother’s response was, “A closed mouth can’t be fed.”
How many of us does this apply to? I’m guessing a whole lot. I know I’ve been guilty of not always asking for what I want and then being miffed that I didn’t get it. I’ve also listened to people “just vent” about work, colleagues, you name it, knowing they had no intention to address the situation. They just wanted to complain rather than assert themselves by opening that closed mouth and speaking up.
Sometimes when people don’t speak up it’s because they are afraid of hurting someone’s feelings or afraid of conflict. Or they feel bashful about voicing their concerns. Maybe they’ll be told they are wrong. Or maybe the other person will take offense. Or maybe nothing will change.
I’ve seen this with patients, friends and family members when it comes to their own healthcare, particularly when it comes to the physician-patient relationship. They have questions or concerns but they don’t want to say anything to their healthcare provider. They usually fear their physician will get angry that his or her knowledge and professionalism are being questioned by a patient. Sometimes they say they don’t want to bother their healthcare provider. This I see most in new parents who are afraid to call their pediatricians when a child might be sick. My usual response is, “If you take your kid to the office and he’s not sick, they’re still charging you for the visit. You get billed whether your child is sick or not.” That usually convinces them to give the office a call. And finally, patients are sometimes embarrassed to admit they don’t understand what their provider just told them.
But if we want to get the best health outcomes and be fully engaged in our healthcare, we have to put those thoughts aside. A closed mouth can’t be fed. It also can’t prevent a medication error, point out inconsistencies in lab results or ask for important clarifications.
I know it’s uncomfortable to go against the grain of what we’ve been taught for so many years: Being quiet makes you nice. And being nice makes you a “good” patient.
Being assertive, however, makes you a great patient. It shows you are involved in your care. And patients who are involved in their care have better outcomes. And better outcomes lead to successful physicians.
So here are some resources to help you become a more assertive patient:
Members of the organization Health Care for All’s Consumer Health Quality Council created this guide to help consumers navigate hospitals’ customer service channels and to give general advice on how to address healthcare quality issues. It gives practical advice on how to speak up including:
- Being clear about your expectations. What do you want? What do you expect the hospital to do? This allows the hospital staff to know what will help.
- Using staff in the patient and family relations department as a resource to discuss your case and how to best proceed.
- Resolving problems with face-to-face conversations to achieve better understanding.
The guide also includes “Stories of Harm” to illustrate how not speaking up can negatively affect your health.
This blog post by Heal Health Advocacy gives some great tips on how to present yourself in an assertive manner. Some of my favorites are:
- Use Empathic Assertion
First, recognize how the other person views the situation and then express your needs.
- Be a Broken Record
Prepare the message you want to convey and, during the conversation, keep restating it using the same language.
- Use I Statement
Use “I want.” “I need.” or “I feel.” to convey basic assertions.
This guide from across the pond – it was created by Scotland’s NHS – talks about problems caused by the lack of assertiveness and misconceptions about being assertive and provides specific assertiveness strategies for you to practice.
Australia’s Better Health Channel complied this list of 10 tips for being assertive including:
- Aiming for open and honest communication by respecting others when you are sharing your feelings, wants, needs, beliefs or opinions.
- Taking a problem-solving approach to conflict and trying to see the other person as your friend, not your enemy.
It may seem tough to be assertive at first. But as you keep practicing, you’ll become more comfortable with it. And if a healthcare provider isn’t open to your new-found confidence, remember there is always a different physician out there who will be willing to work with an assertive patient like you.
Jennifer Thew, RN, MSJ
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