Assert yourself to enhance success

Medical Post
Helping Hand Column, February 22, 2005

Many physicians find being assertive difficult, but you're more likely to get what you want if you ask for it

Q: I am in a practice with a colleague. While I am responsible for half of all our expenses, I do not feel I have half of the rights within the office. My colleague makes most of the decisions. The office staff does things her way even if I ask otherwise, to avoid her reaction. How can I learn to assert myself better?

A: Assertiveness is a trait that enhances our success in all aspects of our life. Yet, for many physicians, being assertive does not come easily or naturally. Most of us have been taught to be "good"—to work hard, listen well, try to please others, be pleasant and easy going and considerate, and not focus on our own needs because that would be "selfish." This is essentially right, and such behaviour has helped get us to where we are now. Such hard work and focus on others has contributed to our studying hard, getting good marks, getting into and through our training in medicine, and becoming well-regarded physicians.

While behaving like this is not wrong, restricting our behaviour to this is not entirely right. This has helped us get this far, but we need to learn more skills to achieve further success. Being assertive is one such skill.

Asking does not come easily to us. We often feel that we should not have to ask, that others should just know what we want and/or deserve and give it to us. I don't think there is anything much harder than asking for what we want. At the start, you need to define what it is that you want to say. It helps to be clear, direct and succinct. Watch out for preambles and modifiers, words and phrases that make it easier and softer, such as: "If that's all right. . . . I hope you don't mind if. . . . Sort of. . . . I may be wrong about this, but. . . ." since they dilute or discount the point you want to make. Plan out your thoughts, and keep it short, simple and quick. "I would like my charts filed in this manner." This will be your "bottom line."

You have to make yourself heard. I am sure you can recall coming up with a great idea in a meeting, only to have someone else bring it up a few minutes later and get the accolades. Why is this? Bring up your point in a simple declarative statement, instead of a question. "I suggest . . ." instead of "Do you think it would work if we. . . ." Also, you don't have to wait until everyone else has spoken. Interrupting someone can work to your advantage. Take as much time as you need and speak confidently. Don't let others interrupt you; ignore the interruption if it occurs and just keep on talking.

Use the "mirroring" and "broken record" techniques to state your point assertively. Listen to the other person, and then respond with a two-part statement. The first part is the "Yes, I hear you," in which you mirror by restating what they have just said or what feelings they have just expressed, so they know you have heard them. You reflect back their point of view without necessarily adopting them. Yet, don't stop here. Continue on to the second part of the statement, in which you stand your ground and state your bottom line. Thus, whatever the other person says, you can agree with something of what they have said; and then state your bottom line. You can repeat this over and over as they bring up new points, like a broken record. This has at least two benefits—your point is reinforced as you say it repeatedly, and you do not go off on a tangent since you keep coming back to your bottom line and making your point.

Once you ask for what you want, it is helpful if you can reframe it, to show the other person how it can benefit them, too. Often, the needs of both parties are not mutually exclusive. Highlighting how it helps both of you can help you work together toward the same goal, instead of remaining at odds.

Just asking for something, no matter how clear and direct, is not always enough. There are two more factors that help meet the goal. Set a deadline, by which your stated expectation must be met. "When do you think you can get this done by? . . . I would like to have this completed by. . . ." Then, define a consequence if this deadline is not met. A consequence can be serious, but often it is not dire—just a way to ensure that you can follow up. "If I do not hear back from you by tomorrow afternoon, I will call you."

Sometimes, you just need to decline or disagree. It is OK to say no. Follow these three easy steps : 1. Open your mouth. 2. Say "No." 3. Close your mouth. We often continue on to explain, apologize or make excuses in an attempt to please and retain approval, yet this is not always necessary. "No" is a complete sentence.

Here are some concrete steps in asserting your needs.

• Recognize when you need to ask for what you need.

• Do your homework and find out what is reasonable, possible and works best.

• Ask clearly and directly.

• Show how what you want will also help the other person meet their needs.

• Then, stop talking.

The key is to be strong and assert your needs, without being destructive. State your needs calmly and surely, to ensure that you will be heard. Speak confidently, and if you don't really feel confident at first, "fake it until you make it."

It gets easier with practice, especially when you see the results it brings.

Mamta Gautam is an Ottawa psychiatrist who specializes in treating physician patients. If you have a question you would like addressed in this column, please contact Dr. Gautam at mgautam@rogers.com. Please include “Helping Hand” in the subject line. All inquiries will be confidential. Your questions will not be replied to, but may be selected to be answered in this column, which is intended to be educational, not therapeutic.