DR. HIWA K. SAAED
How to stand up
Assertiveness and Patients
Assertiveness and Other Health Care Professionals
Assertiveness and Employees
Assertiveness and Employers
Assertiveness and Colleagues
Take an active role in patient care.
Initiate communication with patients rather than wait to be asked
Convey their views on the management of patient drug therapy
to other health care professionals.
Finally, try to resolve conflicts with others in a direct manner but
in a way that conveys respect for others.
Before reading further, stop and ask yourself these questions:
1. If a group in your community asked you to give a speech on medication
use, how would you respond?
2. When a patient is hostile, how do you tend to respond?
3. How many patients and physicians you talk with know you by name?
4. How often do you make it a point to talk with patients getting new
prescriptions to make sure they understand their therapy?
5. How often do you counsel only if they ask questions?
6. How frequently do you look at profile records and ask patients questions
during refill visits to make sure that:
◦ medications are being taken appropriately,
◦ therapeutic goals are being met,
◦ there are no problems with therapy?
Avoid conflict at all cost
Avoids saying what he/she really think out of fear that others may
‘Hides’ and waits for others to initiate conversation
Put others’ needs above their own
May feel secretly angry or resentful towards others
May see themselves as victims
Aggressive people seek to “win” in conflict situations by dominating or
Aggressive persons promote their own interests or points of view but
are indifferent or hostile to the feelings, thoughts, or needs of others.
May ‘win’ certain arguments the short term, but their behavior may
lead to long-term negative consequences
Assertive behavior is the direct expression of ideas, opinions, and
The intent of assertive behavior is to communicate in an atmosphere
Conflicts that arise are faced and solutions of mutual accord are
Assertive individuals initiate communication in a way that conveys
their concern and respect for others.
The goal of communication is to stand up for oneself and to solve
interpersonal problems in ways that do not damage relationships.
Assertiveness requires that you respect others as well as yourself.
A critical factor in being assertive
“Taking responsibility for our own behavior”
is the ability to act in ways that are consistent with the standards we have for
our own behavior.
When we tell ourselves that other people “make” us feel or act a certain way,
we are not taking responsibility for our own behavior. Instead of changing
ourselves, we try (impotently) to get others to change. However, the only
power we have to effect change in any relationship is to change our own
e.g., you may wish that your boss, who tends to be very negative during
annual performance evaluations of staff, was more supportive of your work.
However, just hoping that she would be more positive in her evaluations will
not resolve this issue. You must take active steps to change how you respond
to her criticisms rather than waiting for her to change her approach.
skills for assertive communication
initiating and maintaining conversations,
encouraging assertiveness in others,
responding appropriately to criticism,
giving negative feedback acceptably,
expressing appreciation or pleasure,
making requests, setting limits or refusing requests,
conveying confidence both verbally and nonverbally,
and expressing opinions and feelings appropriately.
Theoretical Foundations ‘Irrational beliefs’
Behaviorists believe that passive or aggressive responses have been
reinforced or rewarded and thus strengthened.
Aggressive behavior often works in the short term because others feel
intimidated and allow aggressive persons to get what they want.
Passive behaviors are reinforced when individuals are able to escape or
even avoid conflict in relationships and thus escape the anxiety that
surrounds these conflicts.
Irrational beliefs that interfere with
assertiveness. These beliefs involve
1. Fear of rejection or anger from others and need for approval (everyone
should like me and approve of what I do)
2. Overconcern for the needs and rights of others (I should always try to
help others and be nice to them)
3. Unalterable personality characteristics, unchangeable (this is just how I
4. Perfectionist standards. (I must be perfectly competent. If I am not, then
I am a failure. Others must also be perfectly competent and deserve to
be severely criticized if they are not.)
an assertiveness technique, teaches people to identify self-defeating thoughts
that produce anxiety or inappropriate anger in difficult situations and replace
them with more reasonable thoughts. As these new thoughts replace the self-
defeating thoughts, they begin to be incorporated into the person’s belief
For example, as a pharmacist you may feel “used” by a boss who always counts
on you for emergency coverage. You might currently say to yourself, “I don’t
want to come in to work on my day off this week, but if I say ‘no’ the boss will
get mad, and that would be awful.” Because this causes you anxiety at the
imagined catastrophic consequences of saying “no,” your response is inhibited.
A more rational thought process when faced with such a request would be “I
don’t want to work on my day off this week. It is my right to say no. I am not
responsible for solving all the problems my manager has in finding backup
coverage.” This thought reduces anxiety and frees you to practice new, more
assertive responses to difficult situations.
Assertiveness skills required in relating to patients:
Willingness to initiate communication
Encouraging patients to be more assertive with you
Appropriate response to angry patients
Turn criticism into useful feedback
Do not transmit messages through a third party.
Assertiveness skills required in relating to physicians:
No need for anger/ or apology
Always introduce yourself
Apologizing makes you seem insecure and unassertive
Do not put the physician ‘on the spot”
Prepare your recommendation and keep current references ‘in reserve’
Do not expect a ‘pat on the back’
Assertiveness with Employees
Talk in private
Be specific in your approach to the problem
Do not become defensive
Positive feedback is as important as negative feedback (specific praise)
Assertiveness with Employers
Five responses that are helpful in situations of criticism:
Getting useful feedback
Agreeing with criticism
Disagreeing with criticism
Fogging; involves acknowledging the truth or possible
truths in what people tell you about yourself while
ignoring completely any judgments they might have
implied by what they said.
Delaying a response
Assertiveness with Colleagues
The best response is to ‘delay’ your response
Resist the urge to change response from ‘no’ to ‘yes’
Assertiveness is a style of response that focuses on resolving conflicts
in relationships in an atmosphere of mutual respect.
To be assertive, each person must be able to directly and honestly
convey “This is what I think,” “This is how I feel about the situation,”
“This is what I want to have happen,” or “This is what I am willing to
This type of communication allows people to stand up for their own rights or
for what they believe in without infringing on the rights of others. You also
attempt to understand the other person’s point of view even when there is
The focus is on problem solving rather than turning the conflict into a
“win/lose” situation that damages the relationship.
1. Compare assertiveness to passivity and aggressiveness.
2. In what way(s) should pharmacists be assertive with patients? With
physicians? With colleagues?
3. Describe a way to handle criticism without losing self-esteem or
4. How can assertiveness be used to resolve conflict?
5. What is “fogging”?
A patient has just seen their GI specialist who wrote her a prescription
for nifedipine. The patient presents the Rx to their pharmacist. While
interviewing the patient the pharmacist is asked by the patient what
nifedipine is supposed to treat. The pharmacist indicated that nifedipine
is used primarily for blood pressure or other cardiovascular problems,
but, that it can be used for other indications. The patient takes the
prescription and leaves abruptly. Less than 30 minutes later an angry
physician calls the pharmacist and says: "I do not want you to counsel
any of my patients on their prescriptions in the future since you don't
seem to know much about drugs."
Case Study Questions:
Is being assertive appropriate in this case?
If so, what is an appropriate assertive response?
If not, what should the pharmacist say or do?
A patient approaches the prescription counter where a young female
pharmacist is working. The pharmacist greets the patient. The patient
then asks if he can speak to the pharmacist.
A patient returns to the pharmacy two days after having a prescription
for an expensive blood pressure medication filled. The patient slams his
bottle down on the counter and angrily states that their bottle was 5
tablets short. "Can't you do anything right around here?"
A pharmacist who is working alone is counseling a patient about her
prescription. During the counseling, the pharmacist notices another
patient impatiently waiting to drop off a prescription. After the
counseling is completed with the first patient, the pharmacist greets the
"impatient" patient who simply glares at the pharmacist and does not
respond to her questions. The pharmacist, in an effort to smooth things
over, says to the patient, "I am sorry you had to wait a few minutes, but,
I try to provide the best possible care to my patients and this does take
time." Was this a good assertive response?
A pharmacist has just finished counseling a patient about the new
medication to treat the patient's high cholesterol. The pharmacist used
the prime questions and feels like the patient really understands how to
use their medication correctly, and what to do if there is a suspected
problem with their medication. But, just to be sure, the pharmacist
decides to use final verification. He says to the patient, "Just to make
sure I didn't leave anything out, tell me again how you are going to use
this medication." The patient responds, "Well, I guess I am supposed to
take one tablet each night at bedtime, but, you know I am really not
sure about taking this medicine." How could the pharmacist persuade
this patient to use the medication when there appears to be some
doubt in the patient's mind?