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49 thoughts on “Patient Assertiveness

  • Pingback: Tweets that mention Patient Assertiveness | Reality check | Rheumatoid Arthritis Warrior --

  • July 16, 2010 at 8:27 am

    i am a nurse.. i would like to hear you say.. i cannot do this any more.. take it out and lets take a break

  • July 16, 2010 at 8:33 am

    i am a patient.. i would like to hear… i am going to take a break ..i need one and i thing you do too

  • July 16, 2010 at 9:05 am

    Patient Assertiveness is often mistaken or labeled “defiance” or “emotional hysteria”. I told my hubs one day when leaving the office of an… ahem… medical personel, “maybe he should place his balls in the palm of my hand and I will squeeze. When he says it hurts, I’ll squeeze harder and explain to him how I feel he is being dramatic” I know, not lady like but darn if I don’t get frustrated by their attitudes. I am not a complainer by nature so when I do, you can bet it’s above my threshold which it has been for a while now. I still get up every day with one foot hitting the floor and one step going forward. That is a positive. Do you think they understand that? Most don’t. I want compassion above all things. If you can’t cure then at least show me you understand my plight. Don’t make me feel guilt or shame about my inability any given day. Oh and about my weight being slightly over the acceptable… sawed off!! Your the one who put me on the prednisone and then told me it’s the HARDEST weight to shake. Good grief. Okay my rant is done. Tazzy

    • July 16, 2010 at 9:24 am

      No, I think they have NO idea that we struggle just to walk around, just to get there to have the test or whatever. But still no excuse for the lack of compassion & ridiculous labeling of patients as defiant if they say ouch.

  • July 16, 2010 at 11:41 am

    I am by nature a quiet, polite person. I had to become assertive to get my RA diagnosis. I had to become assertive for other unrelated hospital stays. My opinion is that we tend to think too much about how other people like a nurse are affected by our needs or how we might look to other people- instead we need to think like Nike- “Just Do It” or “Just Say It” or “Just Request It”. In other words be a “polite” squeaky wheel- for example if the issue is “this iv line is killing me” don’t even let any thoughts whatsoever enter your mind such as they will think I am complaining, the nurse will be pissed, etc. Just say it. “We need to fix/stop this now”. Or just say “You may be right that this is my Fibro worsening but I feel something else is going on I want the CCP test now” instead of thinking “my Dr.will label me a pain or think I think I know more than him”. No thinking. Just do it.

    • July 16, 2010 at 12:00 pm

      Yes, I agree. & I’m guilty of saying, “I can’t ask for ______ because my doc will label me a pain.”

  • July 16, 2010 at 11:42 am

    Remember that when you speak out, you are speaking also for the other patients that health person comes in contact with. They do need to know that what they are doing hurts. As you noticed, IV’s don’t have to be done so roughly, and some people are better at it than others. If the technique is lousy, they need to learn to do better or not do it. When they do damage to your arm, they are spoiling that area for the next person to attempt an IV start.
    Also, I always tell them if they do a good job and thank them!
    Good for you for taking it up with the supervisor!

    • July 16, 2010 at 12:02 pm

      Thanks, kmom!
      I do that too. I thank & praise every tech who does a decent job. I even bring brownies to the secretaries! Unfortunately, a little negative feedback is also sometimes needed.

  • July 16, 2010 at 11:54 am

    I work in a law office, so I have learned to be very assertive when/if the need arises. I believe that several things help me with this:

    1. What I have to say is important.

    2. My wants and needs are important.

    3. Your opinion of me is none of my business.

    4. I am paying you to provide a service for me and I expect it done with excellence and to my standards.

    Items 1-4, above, are the beliefs I have. I do not vocalize them to others, but it comes through in my conversations.

    5. I don’t wait for the other person to take control of the conversation, but rather, I begin immediately by saying “Hi. I need you to use the butterfly, and here is where you can generally find a vein.” If the tournequet is too tight, I either take it off and say “it was too tight”, or communicate that it’s too tight and I need the person to loosen it.

    I am not arrogant or rude. It’s a business transaction, and I am the buyer. My husband (who is a training manager for WalMart, so I don’t have problems communicating with WalMart employees..LOL ) says that this is “assertive communication.”

    Hope this helps.


    • July 16, 2010 at 12:06 pm

      Very nice tips, Lisa. I will coach myself up w/ your words. I do great at WalMart, too or with other transactions – or even when my kids are the patients. There’s just so much humilation involved when I’m the patient. It’s hard to overcome years of mistreatment and a belief that it won’t do any good to be assertive.

  • July 16, 2010 at 12:18 pm

    this one is so difficult – we’re taught to submit meekly anytime somebody in a white coat goes by and there is a significant amount of unlearning that has to take place before you can get to being assertive.

    My best tip is to remember that you are paying them for a service, much as you’d pay a plumber. Whether you pay them directly, your insurance company pays them or your taxes fund their salaries, you are a customer receiving a service and you are the reason they get paid. Would you accept this from a plumber fixing your toilet? An interior decorator botching your living room? It may not get you in full warrior mode, but remembering that they are not doing you a favor, they are doing a job can help to begin that mental shift into a place where you can draw a line and speak up for yourself.

    • July 18, 2010 at 8:44 pm

      I agree, Lene. I don’t know what it is about that white coat. I’ll try to imagine them in plumbers boots!

      • December 18, 2011 at 1:26 pm

        Perhaps imagining them bent over with plumbers crack? hehehehe. I always say I can be a hard stick. I have small veins that roll and seem to go dry when hit with a needle. I say it right when they come in. I point out spots that have worked in the past. I was an EMT for 8 yrs and have always tried to think of the patient as if they were my family member. I also tell them you get 3 tries then i need someone else.
        For the most part it has worked. I try to be pleasant and throw some humor in there.
        good luck!

  • July 16, 2010 at 12:30 pm

    Kelly, I completely understand the battle to overcome behavior and thought processes which have been modified over a long period of time!

    Perhaps you could look at your assertiveness with medical personnel as a clinical trial of your own. Keep a log of what communication techniques you tried and the subsequent responses. You might even include subjective material such as your mood and energy levels that particular day. There will always be “the human factor” and some negativity involved, but I believe you will be – pleasantly – surprised.

    Please do not think I am trivializing the difficulty – either of the disease of of dealing with people. I am not. I simply don’t want us to forget who we are: we are Warriors and children of the King. Fighting battles is our business, and we are more than conquerors. 🙂


  • July 16, 2010 at 12:49 pm

    I grew up in the era where if you complained you were a trouble maker. It was put up or shut up. The Doctor, the teacher, the police officer, etc. all knew better than you so don’t say anything about any problems. However, now I see a change people no longer stay silent and in some cases it;s good to speak out. I have had to change my way of thinking since being diagnosed with RA and other health issues and it has taken me quite awhile to adjust my thinking about my health issues. I have learned that I can change doctors that I do not have to be intitmated by their egos, I don’t have to take medication that makes me sick, or sit in a waiting room for an hour and half waiting for cataract surgery. I am a person and I am paying for the services rendered to me and I am polite when I tell the doctor, nurse, receptionist etc. about my situation. The days of being silent and suffering are over.

    • July 18, 2010 at 8:51 pm

      Arlene, I hope we do see a change as more of us take this position.

      If we all left and re-scheduled when the wait was over 30 minutes, I wonder whether that would impact (via their pocketbooks) for example. I have lost so many hours waiting, but I’m over 5 minutes late, I’m re-scheduled without apology. Not a 2-way street right now.

  • July 16, 2010 at 1:28 pm

    One thing I do is write down a list of my questions and/or statements. When I get to my appointment I read from this list. I always get cold feet when it comes to speaking up to the doctor and with a list in front of me I get to the point & save time. My doc didn’t seem to mind the first time I did it especially since I explained why I did it this way.

    For me it’s easier to frame my questions in the peace of my own home than in the spur of the moment at an appointment.

    • July 18, 2010 at 8:53 pm

      I’ve had some docs act like a list is acceptable, some not. Maybe as they are more common, they will be more accepted.

  • July 16, 2010 at 1:40 pm

    After having many healthcare experiences as both a former R.N.; and then on the other side as a chronically ill patient, I have learned to be much more assertive than that 19 year old nursing school grad who was told she looked too young to be a R.N. I took my growing confidence and assertiveness as a nurse, and then had to apply it to being in a much more powerless position of being the patient. I try to state my needs in a kind, yet firm way, and state my concerns and questions in a concise manner. I find writing thoughts/issues/questions out before my healthcare visits helpful, as well,in achieving my goals. It’s our bodies, it’s our lives, and it all directly affects our loved ones. If nothing else, we owe it to them to be assertive.

  • July 16, 2010 at 3:53 pm

    I have horror stories to tell from failed experiences in “asserting” myself with healthcare professionals. Unfortunately for me personally I have been beaten into submission by nurses and no longer assert myself. I simply say thank you and please and compliment whenever I can.

    I think that burned out nurses and poorly trained LPNs and MA do not know how to deal with patient emotion or conflict. They are unable to separate themselves personally from the situation and will vigorously attack any patient who challenges them.

    Example: Last year I was at work and received a call from my rheumatologist office (MA) that I needed to reschedule an appointment. I was tired physically and upset because that meant that I would need to reschedule a second appointment I had that day. Because I was working, I tried to double up on appointments to minimize time away from work. The MA thought I was rude for asking for help with the coordination. I even apologized to her for being tired on the phone. (I am anemic and neutropenic) Being tired, my voice sounded whiney. I did not curse or say anything rude. The ignorant MA complained to my rheumatologist and my rheumatologist wrote me a nasty letter tellimg me that if I were ever rude again, she would kick me out of her practice. She eventually did and I found a much better, established rheumatologist who actually cared about me. I was devastated by the incident though, emotionally crushed to have that happen as a patient.

    It is a myth that the patient is in charge. The doctor can kick you out at any time. So handle your complaints gingerly if at all possible. Look for another doctor if possible because it’s not worth it, you need a doctor and staff who actually care about you.

    • July 18, 2010 at 9:23 pm

      Denise, I was sad when I read your comment “I no longer assert myself.” I think many of us share your feelings about being “beaten into submission” by bad nurses and doctors. This blog was about my struggle to move forward in spite of that. I think you are doing that in some way too by voting with your feet and leaving to find a new dr. At least “the patient is in charge” in that way.

      I’m glad you found a better and more caring doctor. I’ve had to leave a caring one to find one that is more knowledgeable. But both would be nice. :rainbow:

  • July 16, 2010 at 5:15 pm

    This was such a great article. I learned so much from it and from the responses. I am not very assertive myself except when it comes to my children. You can bet in the future when I go to the dr. appt. I will speak up and use some of these suggestions. Thank you for posting your experience. Sorry you had to go through it.

    • July 18, 2010 at 9:25 pm

      That sounds familiar Krist. Mother’s instincts overcome; but when it concerns ourselves, we are more intimidated. Maybe if we figure out why, we can do better.

  • July 16, 2010 at 6:28 pm

    Lisa, Thanks so much for the pointers…… I have always felt and related to the doctors and nurses your way (politely) and they have always responded in a positve way, at least I have always perceived it as positive.(hmmmmm) Glad to see it written down!! We are all precious in God’s eyes and should be treated that way.

    • July 16, 2010 at 6:30 pm


  • July 16, 2010 at 8:58 pm

    I guess the good outweighs the bad. Apparently, I have suppressed some of my “not so good” appointments. I’ve had my share of evil vampires and nasty nurses! But I have found my ost assertiveness came upon the Office Manager of my Rheumatologist (aka Gatekeeper)! In my personal experience, I have one who is the most controlling, insensitive, downright uncaring individual! Because if her I had to endure an unnecessary Bone Marrow Biopsy! She believed it was HER “decision” WHEN I should see my RA doctor in order to be accepted into a study with the National Cancer Institute, after being diagnosed with Lymphoma. Since I missed the 8 week window–the Clinic received a very assertively honest complaint from me during a major flare-up…(oh it’s so much easier to “speak honestly” when the pain is a 10 plus!!!). Let me just say after an apology from my Doctor (who BTW had no idea she never scheduled my appointment), another nurse on staff and the Clinic; she now will smile and do ANYTHING I ask. What is the saying…keep your friends close and enemies even closer!!!!It works!

    • July 18, 2010 at 9:38 pm

      I have also found some gatekeepers to be the worst. They can also mess up your billing & cause much trouble. I often wonder whether the dr realizes how many messages are not returned or how many times we have to ask before there is a response.

  • July 16, 2010 at 9:34 pm

    Nurses that are nurses for the RIGHT reason would never do this to anyone. It goes against the philosophy of nursing.

    I am sickened by some of the storries I hear. I do get more respect when people realize that I am an RN but many times they approach RNs with as much suspicion as patients who are not. Many times we know too much and are trying to self-diagnose. It is really really frustrating.

    The poor experiences that I hear from RNs are particularly upsetting to me. But it is hard to advocate for yourself. Patients are much more educated now and I think that is a good thing.

    My advise… knowledge is power. Ask questions, ask questions, ask questions and don’t EVER accept mistreatment or answers that dont make sense. Always ask if you don’t understand.

    Heather RN

    • July 18, 2010 at 9:43 pm

      Thank you Heather. What do you do if it’s the nurse that doesn’t understand? I’ve had RA nurses that thought it was annoying when I wanted my temperature taken (I have an RA fever most of the time) or who don’t understand why I take omeprazole or whether it matters that my methotrexate prescription says tablets or liquid… It’s hard when the nurse knows less than you and you need her help.

  • July 16, 2010 at 10:56 pm

    I am wrong person to give advice here, I am the biggest pushover you will find. I have been getting better though – I get angry and then finally I’ll say something…

  • July 17, 2010 at 8:01 pm

    My late brother, who went through cancer and later a kidney transplant, inspired me to become an assertive advocate–not just for him, but for me, too. For drawing blood or inserting an IV, the tech/nurse gets two tries. That’s it. Then I request someone else. I will even do that to a doctor. I have to live with the bruises, they don’t. I had only one person try to give me a problem. In legalese, you say “I withdraw my consent to have you touch me–get someone else please.” With nasty IV centers, see a nursing supervisor and if she is nasty, ask for her supervisor’s name. If you need to, ask for a hospital administrator to contact you. It really matters. I use words like “this seems like it is beneath the standard of care for this treatment/care.” A nurse may not understand it, but the administrator sure will:) I am very lucky. Magee in Pittsburgh has the nicest infusion center. The nurse kept apologizing (she got it the first time, too). They offer drinks, warm blankets, anything. Even WiFi. If it weren’t for the needle, I’d feel like I was at a spa.

    • July 18, 2010 at 10:14 pm

      Well, I know great advice when I hear it and I plan on practicing so I cant say “I withdraw my consent” when I need to or “This seems beneath the standard of care.”

      I know there are some newer patient-centered infusion centers springing up. I’ve seen a couple online. The medicines are so expensive and the patients are in so much suffering, it makes sense to spend a little of the money making them comfortable, doesn’t it?

  • July 18, 2010 at 3:56 am

    I too am an RN and am very saddened by your experiences.
    I believe our experiences make us who we are and I am a much better RN who has a lot of empathy since my father was diagnosed with cancer and died. Then a year later I was diagnosed with RA.
    I would like to hope that most nurses are in the profession for the right reasons, but obviously not everyone gets a nurse who is competent at their job.
    If I was hurting a patient unintentionally, I would prefer them to point it out to me. I like what Lisa had to say above. I usually point out my best vein too, say that it is in deep but is easy to find. Most blood suckers find it easy, but I have also had the stab you several times while the needle is already in feeling so I know where you’re coming from.
    Good luck with the assertiveness training. You are a fierce mother bear, try to put that power into words for yourself as well. You deserve it Kelly.

    • July 18, 2010 at 10:15 pm

      Thanks, Joye. I’ll try. I think I’m ready.

  • July 18, 2010 at 12:22 pm

    This really hit home for me. After almost a year of blood tests and few problems, I just had the worst blood draw ever! I told the lady they usually use the butterfly thing, did she listen? NO she had the “I don’t care attitude” so,, after poking me 3 times (in and not completely out) she finally asked for help from a co-worker. I now have a lovely bruise, and made up my mind she will never draw my blood again, and whoever does WILL use the smaller needle.

    • July 18, 2010 at 10:18 pm

      Good for you CJ. There is a lot of good advice on here for examples of what to say. Maybe we should all read these comments before appointments.

  • July 20, 2010 at 12:39 am

    I had an experience last week when I received my Orencia infusion. All of my infusion have always gone smoothly and usually painless. Last week I had a nurse I had not seen before. Usually I am asked what is the best vein for me. This nurse just took my arm and started looking. I politely told her and showed her my best vein for infusions. She stated that she would start one in another spot. I repeated that my best vein was right here and pointed to it. She stated, no, I am going to start here and work my way up the arm as needed. I then told here it was time for her to have someone else come over and start it where I asked and preferred. The nurse backed down and started the IV where I requested. She did a couple of things that caused me pain during that infusion. I can guarantee she will NOT take care of me again. When I go for my next infusion I will request that she is not to be my nurse again under any circumstances. By being a paying consumer I have hired the nurse to do a job. If she/he does not perform up to my expectations I have the right to fire him/her and “hire” someone that does meet my expectations. Kelly, you are doing a great job at being more assertive. It will just take some practice for you to be comfortable with it. Remember it is your body and you have the right to say what does and does not happen to your body.

    • July 20, 2010 at 12:53 am

      Warrior Jamie, you are a good example for me. I know you don’t flaunt it to the other readers, but you yourself were a nurse, so I know you know what should be done. I really think I will copy these comments and read them to myself in the car on the way to the next IV or appt.

  • July 20, 2010 at 11:27 am

    I agree with others who have already posted. I was first tested for Rheumatic Fever when I was 9 years old – that simple blood draw took 7 sticks. When it comes to phlebotomy & IVs, I have been taught by experience to only give a nurse/tech 2 tries. After the second unsuccessful try, I now say, “This isn’t working – I think it’s time to get some help.” So far, I’ve sensed that the other person is usually relieved to not have to continue; relieved that the patient has told them to stop. I’ve been lucky not to run into a nurse who insisted on continuing – I would probably stop being polite at that point.

    Remember Kelly – if you are tense, an infusion will be more painful – so you owe it to yourself to be comfortable with the person administering to you. And they owe it to you to make you as comfortable as possible.

    As an aside, I have found in my experience that men are consistently better at infusion/draws than women – is this a coincidence unique to my experience, or have others noticed this?

    Finally, I was advised by a supervisor who was called in to start my IV – if you know you’re coming for a poke, always drink half a gallon of water the day prior. It “plumps” the veins, making them easier to find, more stable when poked, and less prone to “punch-through”, which is what causes those nasty bruises. It’s amazing how much difference this has made for me over the years.

    • July 20, 2010 at 8:53 pm

      Never heard that about men! But my blood draw was from a male nurse today & he did a good job – no strangling tight turniquet left on 5 minutes. I’ve never laid eyes on a male IV center nurse though. Also, I never heard that about being tense – what do you think could cause that?

      • July 22, 2010 at 10:09 am

        As I understand it Kelly, it’s sort of like the principal that you can control your blood pressure with relaxation techniques – being tense somehow causes resistance to infusion and therefore discomfort. I heard this theory at
        M D Anderson Hospital when my dad was being treated for cancer.

        I hate to seem sexist, but you have added ammo to my gender-based needle skills theory. 😉

  • August 4, 2010 at 8:59 pm

    Yay for you for being assertive. I learned after having, 3 c-sections, gallbladder surgery and a blood clot/PE, a child diagnosed with Autism, Type 1 Diabetes and now Epilepsy that you HAVE to be assertive to get what you need. You have to be you and your childs own ADVOCATE and if a Doctor or Nurse gets snippy with you for asking questions then it is time for a new one. I have had many professionals annoyed with me because I asked about different treatments and not taking their words as God’s word. They are Scientist’s and it is not an exact profession and they are not God. They are there to help guide you medically, but don’t always know exactly what you need or have your best interests at heart.
    So, Good for you and keep it up!!
    Twitter ID: SassyKR

    • August 5, 2010 at 1:10 am

      Good to see you, Kristen. Have you found it much easier to be assertive for you kids than yourself? Don’t know if you’ve seen any of the other posts about them? I have 5 kids & we represent 100’s of dr encounters with their issues (eldest is 20).

      I appreciate your encouragement. Don’t know why it is so much harder for myself. I feel like I’m learning to do it better so I can somehow save some part of my life – and be better able to encourage others to fight. There is so much humiliation involved with an invisible illness. Maybe that’s part of it?

  • August 13, 2010 at 1:42 am

    I stumbled upon this post from another article about anecdotal evidence and patient testimony.
    I justvwanted to say thank you for all the assertive patient ‘tips’.
    I teach (well, mentor) childbirth education classes, and one of the strongest, most talked about, and questioned topics that comes up with parents to be is “how to talk with the hospital staff”
    As “patients” we are in a passive role, as “clients” or even “consumers” we are in an active role, I believe that it is our responsibility to take a lead role in the “story” of our care.
    Birthing From Within teaches the 5 “ates”, which I’ve seen echoed similarly in non violent communication.
    Validate: where they may be coming from/their expeience: “I know you do this all the time…. Or, you probably have seen this a hundred times….
    Motivate: I wonder if you know another way… Or can I suggest…
    Educate: I know my body works well this way….. Or, I found this information/study to show this….
    Innitiate: I’m learning from you, you are learning from me… We are initiating each other into this new way…
    Celebrate: the creative love warrior’s work of assertive communication

    • August 13, 2010 at 11:54 am

      Great ideas, Mendy. Thank you.

      I was a home birth mom specifically because I chose to take the lead in my own care – that is just more difficult in a hospital setting. It has been one of the greatest challenges of living with a chronic illness.

      Have you seen the e-Patient link on the menu? We are walking through a book about learning to become more empowered patients.

  • December 12, 2011 at 6:08 pm

    I have always been a stoic patient. I figured it did no good to complain. I’ve had many surgeries and many, many blood tests. But now I have infusions and things are different. I have (I should say had) good veins that were easy to find without a lot of discomfort. No more. The infusions themselves have ruined some of the veins, and poor nursing techniques have injured others. Now I cringe at the thought of going in for my infusion because I know it’s going to be and hour and a half of discomfort bordering on pain. There is a limited number of nurses, too many patient and too few choices in the area in which I live. It’s best not to “T” off someone that you may have to go to month after month. It’s a shame, but it’s the facts. If it’s too bad, I will let them know. But honestly, most could care less…there’s just too much work to do and not enough people to do it.

  • November 5, 2012 at 6:37 pm

    My approach when someone attempts to start an IV on me is: I don’t mind if you hurt me if you don’t mind when I scream. Then I tell them I can be a hard stick and if they aren’t sure they can get it on the first try to get a supervisor. I also tell them where they can stick and then consciously try to relax. I’m also pretty assertive about not using an adhesive on me, since I’m allergic and it takes days to clear up.

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