8 Ways You’re Begging to Hear “NO” From Patients

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sunrise, Jim Rowe via flickr
sunrise, Jim Rowe via flickr

Ever hear of psychological reactance? Probably not.

Health care education & training on psychology focuses on human dysfunction & disease. Normal functioning gets very little attention. All the wonderful, extremely useful knowledge we’ve built up over the last century about NORMAL human thinking gets ignored. It’s a BIG PROBLEM that makes work far more difficult for providers every working day. Yet very few health care professionals, even experts in Psychiatry, have any appreciation for the way their incomplete knowledge hobbles them in every patient interaction.

It’s a bad new, good news situation. I already told you the bad news. The good news? It doesn’t take much time or effort to remedy this deficit and start to benefit from it. Patients use their normal brain functions to make all their decisions, like whether to let you help them, to coöperate, to argue, to kick you in the shins, to waste your time & make you miserable… you get the idea. Everything you do with any patient depends on theses decisions, so they’re extremely important to you. They make or break your day.

Even psychotic, demented, VERY impaired, confused folks still rely heavily on the very same cognitive processes all of us use every moment of every day to interpret the world, make decisions, and act on them. If you learn a bit about how all people think, what makes them tick as humans, then you can learn simple ways to become more persuasive, to make a more positive impression, build trust, good will, and coöperation, with anyone. It works: I’ve done it to great effect for many years now. Your results won’t be perfect, of course not, people are complex and extremely individual, but your results WILL improve, and soon, more than enough to repay your efforts. Results continue to improve over time with practice. You’ll sharply improve the odds of success in every interaction, and need less time and energy needed to get there. In other words, YOUR JOB WILL GET EASIER. YOU’LL GET MORE DONE, FASTER, EASIER. It’s that simple.

I routinely take on the harshest, meanest, angriest, most hostile & uncooperative patients on a unit, because I enjoy a challenge, and because I CAN. Once more: I CAN, because of skills I’ve learned & developed. I can feel confident that I’ll manage, I’ll find a way to improve things. Think of the freedom in that idea, the power, the confidence that you can control your own destiny, regardless! Victim no more! It’s doesn’t make work perfect – what could? – but it certainly makes it far better. I can honestly say that I have fun with patients, and not just the Peaches, every day. Do you?

That said, today I can offer only one teeny slice of this pie. A simple idea: PSYCHOLOGICAL REACTANCE.

In social psychology, it means something we all experience at times: an instinct or urge to RESIST what others tell us to do. Basically, it’s a technical terms for the ” You’re Not the Boss of Me!!!” instinct. In my teaching, I call this mean beast THE MULE (I’m not a fan of unnecessary complexity.) Perfectly normal, universal human stuff, but still problematic when you’re the one toe to toe with it.  As it turns out, eight common factors reliably promote reactance, based on extensive research & practical application. You read that right: we’re in EVIDENCE BASED PRACTICE territory here. In my preferred language, these factors invite the Mule and incite the Mule, who kicks you in the teeth or leaves you stuck on the hot dusty trail making no progress, so to speak. Not fun!

As you consider the list, consider just how common each one is for patients in hospitals: it simply begs them to resist what any authority figure tells them (That would be you):   Eight Ways To Make A Patient Stubbornly Resistant:

Beware the Mule!!!
Beware the Mule!!!

1) Fear,

2) Confusion,

3) Distrust,

4) Dislike,

5) Hurt pride,

6) A sense of lost control,

7) A sense of lost dignity,

8) Hearing “NO” to a request.


By the way we manage these factors, any or all of them, we either INVITE the Mule or send him packing.

If you assuage fear, you win.

If you heighten it, you lose.

Hurt a patient’s pride, you lose.

Build it, you win.

Tell them bluntly “No”, you lose.

Find another way to frame it (still No but more diplomatic), you win.

Give them credible reasons (from THEIR point of view) to trust you, you win. Ignore this task, you lose. And so on.

With our words, attitudes, and actions, we constantly shift the odds of meeting the Mule, either in our favor or, all too often, against our own interests. It grants us far more influence over patient attitudes & coöperation than most of us think, IF we act accordingly. It’s not “just the way they are”: we don’t have to be passive victims of circumstance at work. We make our own interpersonal weather, our own “luck”, for good or bad, even though most of us don’t realize it.

Also keep in mind:

People in pain, confused people, disoriented people, decompensated psychiatric patient people, all these people experience diminished IMPULSE CONTROL: less ability to wait, to deal with frustration, AND to rein in their inappropriate speech and behavior. The Mule is stronger, closer, meaner, and more dangerous, than usual: all the more reason to keep it at bay.

Do you like meeting the Mule? I sure don’t. It’s well worth a little effort to manage those factors and avoid the Mule, don’t you think? If you doubt it, then my guess is that you’ve never tried it. Old habits & assumptions are stubborn beasts too. The tools I discuss only work if you out them to use, practice with them. Leave them in the box and they’ll rust. You pay the price.

Remember the old wisdom, an ounce of prevention is worth a pound of cure?

I do, and I act on it.

I’m no victim: I learn, grow, adapt, shape my destiny and reap the benefits.

How about you?


I’m eager for feedback, examples, agreement AND disagreement. Teach me, please! I live to learn and grow.


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