In Responding to Someone Being Difficult, Where is Line Between "Assertive" and "Jerk"
May 23, 2012 12:03 PM   Subscribe

In Responding to Someone Being Difficult, Where is Line Between "Assertive" and "Jerk"?

Type of situation I'm thinking of is working with a physical therapist who aggressively insists I do some exercise I've already told them has irritated my joint. (And so complying with their instruction would almost certainly cause further injury--this happens more than you might imagine.)

This type of thing infuriates me. Here's a range of possible responses:

1) Exert all self-control I have and just look them in eye and say "I'm going to pass"
2) Breezily say "You do that, I'm going to stick with what I know is safe."
3) Say "listen, I already told you that hurt my joint. Is there anyone else here I can work with who's able to listen to patients"

The question for me is when does someone cross a line from being innocently incompetent (i.e., they need to follow some set protocol and aren't able to vary from it), versus so wildly inconsiderate as to be willing to cause harm. If it's the second, I find it almost impossible to control myself and not express irritation of some sort...
posted by Jon44 to Human Relations (24 answers total) 12 users marked this as a favorite
 
What about asking them to explain? Something like, "Can you help me understand how doing an exercise that, in my experience, irritates my joint, is in my best interest?"

Then actively listen to what they have to say, and if you disagree (and you likely will), say something like, "I understand what you're saying, but I still feel this is the wrong choice for me. Are you able to partner with me to help find the right choice for me, or can you recommend a different therapist who is?"

It's non-confrontational and about the problem, not the person.
posted by dotgirl at 12:08 PM on May 23, 2012 [26 favorites]


If you want to try a little more diplomacy first, you might want to turn it back on them and ask a question: "The last few times I tried that it felt like it irritated my joint. Is there a way to modify the exercise so it doesn't cause me further injury?" This is a conversation I have a lot with my physical therapist, and most of the time he's able to say "OK, support yourself here instead of there and now try it" or "Well why don't you try this other exercise instead?"

If your therapist continues to insist you do it the same way, and they aren't able to explain to your satisfaction why it's helpful rather than potentially harmful, then you certainly have the right to ask to see someone else. Whether you're a jerk about it or not is up to you, since you won't be seeing them again, though I'd lean toward trying to just be firm (dotgirl's examples of what to say are great), especially if you're going to have to see someone else in the same office.

That's a very specific situation, of course. In general, when difficult people do stupid crap that irritates you, it can be helpful to try to think of what you're trying to gain by expressing irritation: Do you feel like that's the only way to get through to them? Do you want to punish them by annoying them as much as they're annoying you? Will it just make you feel better? In my own personal experience I've found showing irritation is unproductive and actually just makes me feel worse than just calmly and firmly removing myself from the situation, but I know others who feel differently.
posted by rhiannonstone at 12:16 PM on May 23, 2012 [5 favorites]


The Golden Rule works well for almost any situation like this. I.e., put yourself in aggressive/bossy therapist's position and phrase it in a way that would draw a decent response from you. My own proposed phrasing for you:

"Doing that really irritates my joint. Is there another exercise you could suggest?"

Changing therapists is a topic to be taken up with someone else, though. Like the clinic or your doctor.
posted by bearwife at 12:18 PM on May 23, 2012 [1 favorite]


The point where you cross over from "assertive" to "jerk" is the point at which you don't leave the person you're talking to any non-aggressive way to respond to you.

Your 1) and 2) are pure confrontation, there's nowhere to go from there but to the shouting.
3) is borderline: it gives the PT exactly one option other than confrontation (and not a very graceful option if there doesn't happen to be another PT available right at that moment.)

A less confrontational way to express 3) would be "listen, I already told you that hurt my joint. Is there another exercise that would accomplish [whatever you're trying to accomplish] without stressing that joint?" This still expresses some irritation, so I would only resort to it after trying more polite variations on the theme, but it leaves the PT a variety of responses beyond arguing with you.

If that doesn't get you anywhere, you're better off just ending the appointment and finding a different PT rather than putting on the war paint (which might be satisfying in the moment but won't actually accomplish anything.)
posted by ook at 12:36 PM on May 23, 2012 [5 favorites]


"I'm sorry, I'm not going to do that."
posted by empath at 12:48 PM on May 23, 2012 [2 favorites]


1) Exert all self-control I have and just look them in eye and say "I'm going to pass"

'I'm going to pass' is my go-to for when I suspect people don't actually realize my compliance is optional. Also handy when asked for your zipcode or email address when buying things in a story, as is a chipper 'No thanks!'.

But you should find a physical therapist you can maybe feel better about. Unless, like me, you have authority problems in which case it's probably worth it to examine it a little more closely to be sure you're not acting against your own best interest out of a knee-jerk distaste for people telling you what to do.

I don't know you, obviously, and am speaking purely from my own experience and my many failings.
posted by A Terrible Llama at 12:59 PM on May 23, 2012


Oh and also, if it really is a bad idea and you straight-out don't want to revisit it, you can ask them to make a note in your chart so you don't have to have the conversation fifty times.
posted by A Terrible Llama at 1:01 PM on May 23, 2012


"The point where you cross over from "assertive" to "jerk" is the point at which you don't leave the person you're talking to any non-aggressive way to respond to you."


Yes, but situation I'm thinking of is one where they're introducing the aggression in the first place. In general, I can see the value of staying diplomatic, but sometimes replying to a bullying tone with a bit of aggression seems like the only way to get a bullying type person to back off... (thus, response 2 does seem appropriate.)
posted by Jon44 at 1:03 PM on May 23, 2012


#3 is almost assertive, but veers into jerk territory when you say "is able to listen to patients." That's when it moves from standing up for your own rights into attacking them. This, in general, is the line. If you're advocating for yourself, that's good. If you say things to make other people feel bad, that's jerky.
posted by Ragged Richard at 1:04 PM on May 23, 2012 [2 favorites]


I've worked in various client-support roles over the years (though not in physical therapy), and here's my perspective from the other side of your scenario: while I make an effort to give everyone a good amount of professionalism and customer service, the fact of the matter is I always am more eager to help the clients who are polite, cheerful, and appreciative. I'll get back to them immediately and be more willing to handle unusual or urgent requests for them. For the clients who are snippy and assume that I am "incompetent" or "wildly inconsiderate," I will do just enough to get them off my back as quickly as possible. This isn't deliberate, and it's not unique to me – it's universal.

Sure, sometimes you have to get aggressive to get results. But it's a last resort, and it's more effective if you do it very rarely. If you're often finding yourself in situations where you get irritated and ready to snap, consider that you may be contributing to your own irritation more than you realize. If you meet five assholes in a day, odds are the asshole is you.

In this and other scenarios, explain your issue in detail, calmly, and ask about your other options. If you make your case calmly and thoroughly but the person doesn't give you any other options or doesn't seem to listen, or if you just get a bad feeling, that's when you go get a second opinion. You don't need to tell the guy why he sucks or that you're taking your business elsewhere or anything, just go find someone else whose opinion you value.

On preview: how is this guy being aggressive? Is he aggressive or just insistent? There's a world of difference. And if he is deliberately being a jerk to you, escalating isn't going to help, and it's all the more reason for you to go elsewhere.
posted by Metroid Baby at 1:07 PM on May 23, 2012 [3 favorites]


"I've tried that a few times, and it irritated the joint. That seems like it would lead to further injury. Can you explain a little more why I should do it?"

This gives the PT a chance to give you a better explanation and address your concerns. If he doesn't, you move to:

"Okay, I think I understand your reasoning, but I'd like a second opinion on whether it will help more than it will hurt."

Physical therapists have to push their clients some of the time; that can come off as aggression. Even if it is just him being an asshole, what happens after you push back at him in the same way? There's a small chance that he'll learn his lesson, but more likely, you will become the asshole client who won't listen, and you'll have to find another PT anyway.
posted by Etrigan at 1:14 PM on May 23, 2012


"And if he is deliberately being a jerk to you, escalating isn't going to help, and it's all the more reason for you to go elsewhere."

OK, to give specific example: rehabbing knee with PT I trust, "PT I". He's on vacation, so I see his associate, "PT II". He says do this exercise using method x. I explain how normally, me and PT I use method y because method x causes problems (in general, I'm in that 10% of patients who have very sensitive joints, so it's no surprise this is unusual.) PT II says brusquely, "No, the way to do this exercise is method x--you don't need the adjuster pad"

Here's where I think aggression is warranted and helps my agenda of getting PT II to back off. With that type of person, I think patiently re-explaining the issue just sounds effete, and worry that it makes one come off like someone this guy could bully even more.

Is PTII deliberately being a jerk? I don't perceive it that way--more that he's a type (ego depends on seeing himself "on top of others," or a "screw or be screwed" type guy).
posted by Jon44 at 1:20 PM on May 23, 2012


I think you need to just be firm: "I am not going to do the exercise that way; it aggravates my injury." Adding aggression when dealing with aggressive people tends to just escalate the situation; they either get defensive (and therefore escalate) or they recognize weakness under your aggression, and therefore escalate. It doesn't make you less of a target when you engage emotionally; the way to become less of a target for this sort of adult bully is to remain calm, cool, and collected. (And, yes, drowning them in patient re-explanation often works.)

If PT II keeps being aggressive and dismissive, then you need to go to his supervisor and say, "Look, PT II is asking me to do exercises in ways that aggravate my injury. Maybe he hasn't familiarized himself with my chart. He isn't listening to me, and I'm not comfortable with how pushy he's being. I need to work with someone else."

If he is a type where his ego depends on being right? Getting aggressive with him is absolutely not going to have the effect you want.
posted by Eyebrows McGee at 1:29 PM on May 23, 2012 [4 favorites]


This may be their mask for incompetence.

Be the better person. Calmly say "I'm here to get better; I'm not going to do this in a way that will injure me [more]." If he doesn't back off on this then say calmly that clearly this isn't going to work out and don't work with him anymore.

If you want to look at it from the other side, perhaps this guy really thinks he needs to push folks for them to get better. I think that's a little too deadlift-trainer to be doing physical therapy but maybe he gets a lot of folks who are slackers and this is how he deals with them. I think it's more likely he's not a good enough communicator/good enough at his job, period, to be able to adapt the session when you don't do exactly what he had in mind.

Show him the minimum courtesy pity for being in a career he'll never be any good at and avoid him in the future.
posted by phearlez at 1:38 PM on May 23, 2012 [2 favorites]


I think patiently re-explaining the issue just sounds effete, and worry that it makes one come off like someone this guy could bully even more.

They can only bully you if you let them. Just calmly say that you aren't going to do it. Being aggressive is more weak than just calmly stating what you will or will not do.
posted by empath at 1:38 PM on May 23, 2012 [2 favorites]


Yes, but situation I'm thinking of is one where they're introducing the aggression in the first place.

I hear you. But it becomes a question of whether your goal is expressing your irritation, or getting some productive results. A pure-confrontation response is guaranteed to not get you any productive results. Even if the other guy started it.

But:

With that type of person, I think patiently re-explaining the issue just sounds effete, and worry that it makes one come off like someone this guy could bully even more.

To be honest, based on your description it sounds like you're reading far more aggressive intent into PT II's statements than I'm seeing; it sounds more like he's failing to listen than like he's "bullying". I also don't see how re-explaining the issue would sound "effete" unless you, I dunno, lisped while doing it.

Even assuming he is as bullying as you describe, it is possible to be direct and firm without being a jerk about it. ("As I said, I have had joint problems in the past. Using method x strains that joint to a degree that concerns me. Your colleague suggested method Y. Is there some reason you feel method Y is not acceptable?" [...] "OK then, can you suggest a different exercise that won't strain that joint?")

Your responses 1) and 2) are jerk-ish, and for that matter don't even qualify as direct (in that they don't explain why you're refusing to do what PT II wants.) 3) is marginally better but still contains a gratuitous insult ("able to listen to patients") that makes it about the person rather than about the problem. I wouldn't say any of those things unless I were going to follow it up by storming out of their office never to return.

If you really aren't getting through to PT II, end the appointment and reschedule when PT I is back from vacation. Getting into a pissing match with PT II isn't going to accomplish anything other than making the floor damp.
posted by ook at 1:44 PM on May 23, 2012 [1 favorite]


I read this as dismissive, not aggressive. I think that you see this in a lot of client-facing positions where you deal with people who have a different opinion that either policy or expertise would dictate.

Working as a PT, I would guess that you get a fair amount of patient input about exercise choice. Sometimes that's valid, as in your case, but sometimes it's not (there are some cases where a patient might think an exercise is unpleasant, but it's central to their progression.)

This a roundabout way to say, that this guy isn't trying to force you to do an exercise that he thinks will hurt you, or just aggressively assert his will, he's just dismissed your opinion, or disagrees with your evaluation of the exercise. Disagreeing, even dismissing isn't bullying.

Disengage from narrative of "aggression" and disengage from who's right. One possible response would be:

PT II says brusquely, "No, the way to do this exercise is method x--you don't need the adjuster pad"
"I hear what you're saying, but I'm really not comfortable doing this exercise."
- or even -
"I hear what you're saying, and I'm sure you're right, but I'm just not comfortable doing it that way."

The "I'm sure you're right" is actually a bit of verbal subterfuge - it removes his ability to argue about PT principles. You're not going to convince him that you know more PT than him, just set your boundaries and stick to them.
posted by mercredi at 2:35 PM on May 23, 2012 [3 favorites]


The problem with the 'I'm not going to do it that way', is that while it solves a real and/or imagined problem, it doesn't forward the conversation in solving the primary problem (which is how to heal your leg).

The phrase", I'm not going to do it that way": will prevent you from injuring the leg more, but it isn't helpful in getting a valuable treasure in any negotiation - information, or getting you any closer to getting what you want, which is another option. It lets the other person off the hook. I don't know it it matters so much in terms of tone - yeah, if they are brusque in tone, you can be too, but at least move the conversation forward. Something like, "Look, the pain level makes this an unacceptable option. What options (supports, exercises) have you suggested to patients who have significant pain, but still need therapy?

So, if PT II says brusquely, "No, the way to do this exercise is method x--you don't need the adjuster pad"

It is more useful to ignore the tone and focus on the information - and ask why they don't believe you need the adjuster pad, as well as which individuals/what issues are given an adjuster pad, and why yours doesn't qualify. It's also helpful to ask their sense of how much discomfort is acceptable, and if the pain becomes excessive, what other treatment options would be.

I'm saying it's like just like those fabulous martial arts films where the idea isn't to fight your opponent, it's to use their skills against them. If they are experts, then engage them in their expertise - make them do so - and then assess it. It might be limited, or wrong, but then you can say so. Like, "You're saying that pain beyond a 5 would prompt the use of an adjuster pad. That's useful to know. You need to know that I would put my pain at an 7. So, where do we go from here? Can we use the adjuster pad for a week, or do you have more optimal recommendation in mind?"
posted by anitanita at 4:55 PM on May 23, 2012


Is there any kind of documentation in your chart you can refer PT II to? "Yeah, PT1 and I found that way wasn't working and so developed this way. Is that not documented? Is that not clear on my progress sheet/clinic notes/tracking history?" You've then cited an authority equivalent to his own, rather than your own opinion, plus learned more about their internal documentation 'cause this really should be somewhere in your chart for this exact type of situation where one PT is covering for another.
posted by beaning at 5:16 PM on May 23, 2012 [1 favorite]


Thanks very much for some valuable input.

"Disagreeing, even dismissing isn't bullying"

Frankly, I think I'm blind to this and may be the source of my confusion. To me, it seems so outrageous for someone to dismiss my telling them "doing x will cause me a month of pain, and missing out on the rest of the ski season." To have them still insist I do it (so they can check off a box on their treatment protocol, or whatever), I don't know, perhaps I need to lower my expectations, but I just expect the average person, especially one working in health care, to be more considerate than that.

(I've run into a very similar and much more serious situation with hip surgeons, who say they're required by law to do provocative testing, which again causes injury and long-term pain cycles. And again, there's clearly no benefit to the testing (e.g., no decisions are based on it, it doesn't affect the nature of the surgery they plan on doing, etc.)
posted by Jon44 at 5:59 PM on May 23, 2012


If you specifically said "doing x will cause me a month of pain" then he may have thought you were being over-dramatic and difficult. Physical therapists have to deal with difficult, recalcitrant, or I-know-more-than-you types of patients very often. Clients are already annoyed and in pain from the injury and the physical therapy itself is not always comfortable or easy. A friend of mine works in PT and it is pretty common for his clients to say "I could never do this!", "This is impossible!", "I'm too tired/sore/whatever" and then they do the exercise and make improvements because of it.

You are giving an honest assessment that you will be put in long-term pain, but this guy is not your regular physical therapist and has no experience with you. He may think you're just regular ol' Recalcitrant Patient and needs a little pushing.

I think mercredi's ""I hear what you're saying, and I'm sure you're right, but I'm just not comfortable doing it that way" is really good, but you should also indicate that this way is something you and PT 1 have discovered together. Like "I know the way you do it is the normal way and works best for most patients, but in our sessions together PT 1 and I have discovered this way works better for my specific issues. The normal way hurts in a bad-pain, not good-pain way, so I would like to continue to use this modification"
posted by schroedinger at 7:01 PM on May 23, 2012 [1 favorite]


I'm totally awful and aggressive when pushed first. I NEVER feel badly about this.

Why is OK for you to injure yourself because remaining polite is supposedly more important? This is an OK boundary for you to draw, and in any way that assures you are heard.

You can always explain and apologize afterwards with face-saving phrases!

Don't do something that will injure you. That's not in your better interests. In this scenario, the ego of the other person is not above the lasting physical pain you will experience.

You're there for PT! C'mon!!


(I just started with a new Pilates Instructor who is very experienced, vs. my old Yoga+ Instructor who was well-meaning, but kinda new to the biz. I have a back issue and had a c-section last year. In my youth, I studied Ballet and Jazz for 15 years. The new instructor, who recognizes my experience in my movements, doesn't get anal about how my body works, and how it works now. My first instructor was really really ridiculous about movements - like - they had to be exact - even though my body (skeleton) can't do what is requested by design. My spine has no flex, and now has worn discs. Pilates Instructor was totally supportive! New Yoga Guy was trying to force positions that I wasn't able to hit back when I was 4 years old and first noticed my back was different from the other girls in my ballet classes. My arms are double-jointed and I am fine under-extending since that was always necessary for dance, but what counts as "feet parallel" for New Yoga Guy was uncomfortable (feet change after pregnancy!) and New Pilates Instructor knows I know my body and is also female - so she never criticized that aspect of my stance. Pilates isn't being easy on me, she's just about NOT making it painful. New Yoga Guy means well, but has no clue!)

Go with what feels comfortable. ALWAYS. My back is MUCH better now than it was 6 years ago. I would absolutely push back on anyone that was shaming me into re-injuring my back. I can't afford days in bed now that I am a mother. YOU can't afford to re-injure yourself because you are seeking to heal.

- When PT Instructor # 1 comes back, politely inform them of your experience. Everyone needs improvement, your more experienced PT Instructor needs to help Other PT Instructor of how they need to improve.

In the meantime, do NOT aggravate your injury in the meantime.

Good on you for asking this question!
posted by jbenben at 9:05 PM on May 23, 2012 [1 favorite]


This type of thing infuriates me
so wildly inconsiderate as to be willing to cause harm
I find it almost impossible to control myself and not express irritation
sometimes replying to a bullying tone with a bit of aggression seems like the only way
Here's where I think aggression is warranted

You sound...difficult, and I wonder if the perceived conflict has little to do with the physiotherapist's personality and more to do with the PT wanting to minimise conversation with the hair-trigger aggressive person who likes to frame fairly innocuous things as bullying and an excuse for unkind confrontation. Your language is threatening and it's strange that you would be calling the other party a "bully" while throwing these things about. 'Almost impossible' to exert self-control...in a physio office?

Of what benefit is it to you to respond as rudely as you are fantasizing? Yes, yes, you want the PT to back off. But this is silly. PT is making a suggestion; you are free to ignore it -- you don't need to do a song and dance about it, just 'That hasn't worked for me so I'm going to leave that out' or any of the many other fine scripts posted. Obviously you're not going to do the thing you don't want to do, so why are you spoiling for a fight over it?

That you fear courtesy might make you appear "effete" is unsettling, and in this thread you come off angry, to the point where I think people would actively seek to limit their interaction with you if your behaviour is analogous to your attitude here. Perhaps PT is not hearing you because you are already too angry to communicate appropriately; I don't know, but it seems worth considering because this level of anger appears way, way out of line with what's going on.
posted by kmennie at 4:22 AM on May 24, 2012 [5 favorites]


@jbenben: I really feel your pain, as I've had same sorts of experiences. E.g., my hips just don't have a lot of range of motion, but most body workers (Yoga, Pilates) never learned there can be so much variation, so try to push it. That many of them resort to a domineering tone IS annoying and uncalled for.

(Undereducated PT's is such a widespread issue as regards hips that top hip surgeon in Boston area recommends to stay away from them, as they always want to inappropriately increase one's range of motion.)

@kmennie: You didn't read the post and cherry-picked statements (e.g., you claim "PT is simply making a suggestion"--that's not what I'm describing, I'm describing a situation where they refuse to go on in the treatment unless you do what they say.)

Your post is a great example of something I always find on MeFi--the passive-aggressive, "What does that say about you" type post. If the post / I seem difficult to you, you should just move on with your life and not bother responding...
posted by Jon44 at 6:58 AM on May 24, 2012 [1 favorite]


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