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April 16, 2013 5:01 AM   Subscribe

How do you project calmness and authority on days when you're super stressed and tired? Advice from health professionals encouraged.

Recently, several people have commented that I always seem anxious/stressed-out in clinic. I *do* tend to stress out sometimes, because our supervisor likes to make us do as much as possible in our short sessions, but I don't really like having that reputation, and I certainly don't want my patients to pick up on it. I want to appear calm and in control. Is it possible to do that even when you're feeling anxious inside?

I assisted a classmate last week and was really impressed by her conduct. This week I tried to channel some of her mannerisms -- unhurried, measured speech and slower, deliberate movements -- and it worked really well... until something knocked me for a loop and I got anxious again. I think I'm just not good at dealing with things that aren't part of the scheduled plan. Worse still, when I get stressed I have a tendency to get negative and sarcastic. Even worse, I swore in front of the patient! (Not at them, and not to their face, but still within earshot...)

On the social side, I'm pretty sure I actively repel people when stressed, when I really don't mean to. It's just that I get untalkative and my stressed face is my bitch-face :(.

This is my first clinical year so I know a lot the messiness will go away with experience, but I'd still love tips on dealing with stress and putting up a good front no matter what mood I'm in. I've read some similar questions on Ask Mefi, and they're very helpful, but mostly deal with long-term changes in habits. I guess I'm looking for instant, temporary fixes for when something completely throws me out and I have to bounce back quite quickly. Thanks in advance.
posted by cucumber patch to Human Relations (16 answers total) 34 users marked this as a favorite
Best answer: I came to suggest extactly what you observed in a classmate of yours. It has been my experience that tense, stressed out people make faster, sharper, more abrupt movements, and the people that are calm and confident move deliberately but smoothly and gently.

My sister is a very high strung, intense person. She is NOT calm. Ever. My sister's magical trick for projecting calm when she is stressed out (and she has a very high stress job) is to talk to everyone the way she would talk to a new born kitten. Not in a cutesy high pitched annoying voice. Just softly, gently, slowly, not loudly or harshly. It fregging works, let me tell you. Baby Kitten Voice does wonders to keep the speaker calm (it is one of those "if you pretend to be confident eventually you will be and you won't have to pretend" type things), but the people around you tend to echo back the Baby Kitten Voice, and so THEY are more calm and relaxed too. Baby Kitten Voice has been used in some seriously high tension meetings where people have long standing hostility towards each other and rather than the meeting descending in to shouting matches it ended up with the whole room using Baby Kitten Voice. Sometimes when i am properly pissed off at whoever I am talking to and am having trouble maintaining Baby Kitten Voice, I visualize them with a kitten head instead of their human head.

Learn the magic of Baby Kitten Voice. When ever you get stressed immediately switch to Baby Kitten Voice.

Is there anything that can't be improved through the addition of cats?
posted by PuppetMcSockerson at 5:10 AM on April 16, 2013 [69 favorites]

Best answer: I find that the more I complain and express frustration and behave unprofessionally, the more stressed I feel. It's how you perceive your level of stress. What you rate as extremely stressful, your colleague may rate as low to moderate stress.

I found myself stressing and complaining over a volunteer position I hold. Especially in the beginning, where everything was new. You are probably right when you say that the more experience you have, the less reactive and stressed you will be. I was negative as well and would complain about the incompetence and "idiots" to my husband and friends. This kind of behavior only made me more stressed and revealed how stressed and scared I was.

Look at your situation realistically. Is it that bad? It probably could be a lot worse. Try framing your situation differently. Frame it as, "This is normal. This is to be expected and I have what it takes to go in there and deal with whatever comes my way in a professional way."

And, remember to make time for yourself. Most of my stress came from thinking I had no leisure time.
posted by Fairchild at 5:40 AM on April 16, 2013 [5 favorites]

Are you ready? This answer, from Rumposinc, might help you reset your anger into productive professional behavior. Wait a few beats, breathe, and tell yourself "I. Am. Ready."
posted by MonkeyToes at 6:20 AM on April 16, 2013 [1 favorite]

I'm a health professional. It depends on the situation. If you just need to be calm, the baby kitten voice will probably work. If you need to be commanding though, I would suggest you raise the volume of your voice slightly louder than you normally would, but continue to speak in a level tone. It is very important not to let your speech speed up under stress.

Take deep breaths. Excuse yourself from the situation briefly if you need to and that is a viable option.

Also, roleplaying or simulating similar situations is an established and effective way to perform better under pressure. If your clinical program does simulation you may be able to ask to have extra sessions solo. If not, you can have a significant other or friend help you with doing it at home. Have a strategy for the potential situations. If [patient] does X, I will do y, and so forth. Difficult patients often behave in predictable ways.

Example, I find the most difficult thing for me is dealing with drug seekers with borderline personality disorder because they can be very manipulative. My psychiatrist friend told me to always offer such patients a choice, for example: "you can have Tylenol and Toradol, or you can be discharged and follow up on this issue with your primary doctor." Knowing I have this plan in place helps me greatly when I go in to deal with these people. For patients who scream at me that I am incompetent, that I should prepare for a lawsuit, I offer them to speak with the patient advocate or to be transferred to another facility. And so forth. (And none of the threats have ever panned out btw, knock on wood). I hope that is helpful.
posted by treehorn+bunny at 8:14 AM on April 16, 2013 [6 favorites]

Best answer: One time I had a very, very stressful work incident: I mean, I could literally feel my blood pressure soaring, my face flushing, my stomach clenching. I even felt weak, shaky and unsteady, so I took my dog out for a walk to try to calm down. I took her to a nearby park where we were accustomed to letting her play off-leash during off-times (no or only a few familiar dogs around), but this day at that time she was charged by a strange dog, and ran away. My husband was out of town, so it was just me scouring the park and the neighborhood for two hours looking for her. That previous stress? It was like nothing then. Insignificant. I imagined her being hit by a car. Being taken by someone awful. Being abused, lost, alone, injured, starving, dead. I imagined never finding her and never ever learning what happened to her. I imagined calling my husband to say I had lost her.

Well, as I was struggling up yet another hilly street calling for her, breathless and teary, I see someone in the distance coming in my direction, calling for me; it is the father of the family who owns our nearby grocery/greengrocer, where we shop several times a week, and where they like to give my dog ridiculous treats from the deli section, and where I should have checked first thing, or maybe second, after our own house/street. Yes, yes, of course. The dog went there, and they had her safe and sound.

When I came back to face the work problem, I was as steady and temperate as can be, despite still having to deal with the issue... because it just seemed so manageable in comparison. These two things (work incident/lost dog) happened contemporaneously for me, but ever since then I've been able to keep my cool in some difficult and challenging work situations by keeping that feeling in mind, and extrapolating: "of all the awful things that could happen, this is pretty minor (or within my power to make better), relatively," and this has worked for me most of the time.

Apologies for using a thing about my dog, because that may seem weird and/or callous when talking to someone who is working in healthcare, and must deal with the stress of treating human suffering, but I'm really more trying to portray the difference between a situation in which you feel truly helpless and personally terrified, versus a situation that is difficult and high stress, but wherein you actually have a lot more personal power and agency, especially if you can embrace that concept, and thereby remain collected.

Anyway, best wishes to you, cucumber patch; I added this just in case it might help at all with other great advice people more knowledgeable in your field are giving here. Caring deeply about things can be both an asset and a liability, and a very difficult path to negotiate; stay the course, and also take confidence in the fact that pretty much everyone requires time, experience, and reflection to deal with pressure successfully and become both wiser and thicker-skinned in practical ways without losing compassion or empathy.
posted by taz at 9:22 AM on April 16, 2013 [2 favorites]

This is a suggestion from way out in crazy town - botox. Obviously, it won't fix the whole problem, but I found that not being able to frown much made me feel less engaged in other people's stress, and like my own stress was better disguised. I've spoken to receptionists in a couple of settings (dentist's office, veterinary clinic) who have said the same thing.

There are studies that suggest there's a feedback thing (science!) between facial expressions and emotions, so maybe not being able to make a stressed facial expression would help you disengage a little bit.

Plus if you don't like it it wears off.

I've often wished there was an equivalent for the voice - can't help you there.
posted by srs airbag at 9:31 AM on April 16, 2013 [2 favorites]

1. I am totally thrilled at how many people like the Baby Kitten Voice. It really does work. Fantastic during arguments with my significant other as well. :)

2. I think I'm just not good at dealing with things that aren't part of the scheduled plan.

Yeah, I have that problem too, but recently I have tried scheduling unscheduled things, if you know what I mean. Unexpected stuff pops up more often than not, so just plan for it. In my schedule I save a chunk of time to be used for dealing with unscheduled items. If nothing pops up, great! More time to do other important stuff (or to take a break). If things DO pop up, great! I'm ready!

Can you do something like that?
posted by PuppetMcSockerson at 9:48 AM on April 16, 2013

Best answer: I'm also a health professional in a high-stress environment. I've observed that teams led by people who react with typical stress indicators (speaking louder, rushing, barking orders, etc), no matter what their skill level, can be significantly less effective than those headed by calm, relaxed leaders. The problem was, when I started out, I felt anything but calm and relaxed. I felt more like "oh my god, someone is going to DIE, what do I do?" So I did precisely what you attempted: I faked it. I took several deep breaths before I headed into a tough situation, and I consciously imitated the calm, relaxed mannerisms of the people I respected.

It sounded like this strategy worked pretty well for you for a while. Then it unravelled - no big deal. This is a skill like any other, and it will come with practice. The more you do it, the more that other people and team members will react to you positively, and that reinforcement makes it even easier. You convince others and you begin to convince yourself. It doesn't matter if you are a raging magma pit of boiling uncertainty beneath your cool exterior. What matters is that you'll function better, and that helps assuage the anxiety that was the root of the problem in the first place.

"Fake it 'til you make it" is the answer. You can do it (or if you can't, you can pretend to)!
posted by itstheclamsname at 9:49 AM on April 16, 2013 [4 favorites]

I'm also a health professional. Can you identify a little more specifically what things are stressing you out? Is it time pressure with the patients? Are the patients themselves hard to deal with in some way? (low educational level, poor historians, language barriers?) Is your supervisor making you nervous in some way? Are you worried about forgetting something in the patient interview or not knowing the material? Or is it just being in a new environment and not knowing the ropes? If you can identify particular stressors, that would probably help you strategize.

As you know, the worst thing you can do is get frazzled, because the signals you send off (rapid speech, sighing, tense voice) are going to make other people frazzled as well.

I find that being mindful of the effect that stress is having on me makes a big difference. Just mentally saying "this is stressful" helps me step away from escalating it. I have also cultivated something like Baby Kitten Voice--when a patient is being angry or yelling, I find myself speaking lower and slower, and moving slower as well. Refusing to oppose works well too--I use a lot of phrases like "We all want to work with you to help you feel better".

There is pretty much no situation, including the middle of a code, where you can't take 2 seconds to take a deep breath and get yourself together. In less pressing situations, it's OK to take more.
posted by The Elusive Architeuthis at 11:35 AM on April 16, 2013 [1 favorite]

For me, when I am low on water/food, my visible stress indicators are way worse. Voice shaking, hands shaking, etc. So if you're in a go-go-go job, maybe keep an eye on your own intake, to ensure you have a cheese stick (or whatever) and a good drink of water at regular intervals.
posted by LobsterMitten at 1:54 PM on April 16, 2013

I was at a work event recently (think: public event hosted by my organization that will have a dramatic impact on the attendees' futures) and there was a huge, major, end-of-the-world type of problem. Which I was asked to help fix.

Things were hectic for several hours, but when we were done, I was lauded for remaining so calm in the face of a crisis.

But I wasn't calm. I was freaked out and felt like throwing up at the beginning. But I didn't want the attendees to know, because I didn't want to cause extra stress to their day, so I put on a smile, joked around with the attendees while working on each workstation, and kept up "witty" banter to keep them distracted.

In other words, I *pretended* everything was fine, and that allowed me to focus on what I was doing and avoid having other people panic. I know in a clinic setting you can't joke around too much, but for me the phrase "fake it until you feel it" helped.
posted by tacodave at 4:39 PM on April 16, 2013 [1 favorite]

I concur that your physical demeanor is very important, no matter how you're actually feeling on the inside. I once talked with a senior labor and delivery nurse about this--she's this tower of efficiency and calm. I've never given birth but I can imagine soothing she must be to women in labor (which, I think we can agree, is a very stressful situation). In particular, this nurse has a somewhat low-pitched voice and she never shouts or talks rapidly. Just being around her makes you feel like everything will be okay.

So, no matter how panicked you feel on the inside, try maintain the outward indicia of calm. The kitten voice is a great idea!
posted by orrnyereg at 5:02 PM on April 16, 2013 [1 favorite]

Response by poster: @PuppetMcSockerson, that is brilliant! I will definitely try using the Baby Kitten Voice. Or even just thinking about baby kittens might help -- I LOVE cats.

@The Elusive Architeuthis, pretty much all of the stressors you listed are applicable. The biggest one is just feeling like I don't know what I'm doing half the time. I feel like no matter how much I prepare, I'm still going to be underprepared. And whenever things *aren't* proceeding swimmingly I tend to wig out. But that's the perfectionist in me, and that's what I've been talking to my counsellor about. :)

Thanks so much everyone! Now that I know what to do in case of emergency, I feel a lot better now.
posted by cucumber patch at 6:05 AM on April 17, 2013 [1 favorite]

The hospital I work at is in the middle of a busy part of the city. I find that when I make an effort to be super early and find some relaxed place to chill out for a while before my shift starts I'm more relaxed then when I just come straight into work.

Sometimes I just sit in a nice part of the hospital and read a novel for 1/5 an hour. Sometimes I sit at the Starbucks nearby. Sometimes I walk in the parks or near the fountains outside the buildings when the weather's nice. I have co-workers who sit in their cars in the parking garage for a while before they start working.

This relaxing slow start to a busy work environment makes me more calm for what's to come. Good luck!
posted by dog food sugar at 6:14 AM on April 17, 2013 [2 favorites]

I am not a health professional BUT I have been dealing with a tremendous amount of stress lately and it was really getting to me. I could not reset and my behavior was terrible (plus, being so stressed you can't feel your hands is not a good long-term prospect). So I've been taking a series of classes in MBSR (Mindfulness Based Stress Reduction). The whole thing has been excellent, so if you are someone who gets stressed and reactive easily, I recommend seeing it out. Nevermind the daily meditation though (it helps, but obviously going away for 30 minutes to meditate in the midst of a crisis doesn't work) I've found two helpful coping mechanisms. First, is just stepping away. LITERALLY, either leaving a room if possible or just taking one step back. I put my hands down at my sides and take 3 deep breaths before going on. That's the least I can do and it helps to reset things just a tiny bit. The second is an addition I've developed to one of the audio tracks the program uses that's a 3-minute mindfulness preparation exercise. I think it's supposed to set you up to do a longer stretch but I use it throughout the day to just allow myself to release whatever just happened and refocus calmly on the next thing. So if you could find something like that (and can find a minute to step away with it on your phone and some earphones) maybe that would also help you. It's such a small amount of time it becomes easy to use.
posted by marylynn at 2:01 PM on April 17, 2013 [1 favorite]

In EMS, one of the biggest part of our jobs is bringing calm and direction to a chaotic, directionless situation. That may or may not intersect with actually knowing what the hell to do.

One of the mantras is "remember the ABCs," which is a way of saying "when you have no idea what to do, fall back on the basics and that will give you time to get your feet under you". Airway, breathing, circulation, okay, now I'm in the groove.

Are you internalizing the external stressors that other people are experiencing? It's easy to do, particularly if you're in healthcare and you're empathetic by nature. It may help to think of yourself in that situation like an air traffic controller: your job is to create an orderly situation so things can get worked out.

Finally, one thing that I found made a gigantic difference in my personal reactions was forcing myself to take three beats before launching. It feels like an eternity from the inside, but it's almost unnoticeable for others, and it serves to put some thinking space in between me and what I have to do.

Healthcare is stressful, and these skills are all learned skills. You just need to keep working at it, and it will come, but it's a skill. Practice makes perfect.
posted by scrump at 11:48 AM on April 18, 2013 [1 favorite]

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