EMS Revisited: Partner Blues

This article originally appeared in the May 2001 issue of EMS Magazine.

Have you ever worked with someone whose breath could drop a yak at 20 paces? How can you make your captain quit playing polka music in the day room? Is there anything you can do about your coworker who calls everyone “babe,” even patients who fought in World War I?

For better or worse, EMS is a team sport. A partnership, like any relationship, has its ups and downs. Most EMS providers have strategies for talking about clinical concerns with their coworkers. In this article, we will explore strategies for dealing with nonclinical issues.

When something your partner does or doesn’t do bugs you, there are five basic options for dealing with it:

1. Keep your mouth shut and suffer.
2. Get away from this person by quitting your service, requesting a transfer or getting him or her moved to another shift.
3. Change the way you feel about the situation so it doesn’t bug you anymore.
4. Change your partner’s behavior.
5. Recruit others to help you change the situation.

No single solution works for all situations. There is a principle in medicine known as “Diagnose before you treat.” When dealing with problem partners, it’s worthwhile to spend a little time thinking the situation through before deciding on a course of action.

Keeping your mouth shut and suffering through sexist jokes, voluminous intestinal gas or chainsaw snoring is an option most people would rather avoid. However, if what bugs you is really a pet peeve of yours, not something that most rational people would have a problem with, then this may be the best option. One paramedic complained that her partner was always waving at people he didn’t know. Even though it bugged her, she realized that almost everyone else thought it was an endearing quality.

Quitting your service or requesting a transfer is often the best option when your safety is at risk. Partners who tailgate, wave at Hell’s Angels bikers with only one finger, or think the bench seat is a receptacle for dirty IV needles probably should be moved to C shift, if they are allowed to work at all.

Changing the way you feel often comes from quiet reflection on the situation. You may realize that by addressing everyone as Mr. or Mrs. so-and-so, your partner intends to convey respect and esteem. Even though it contrasts with your informal style, you learn to appreciate the spirit behind her actions.

Changing a person’s behavior is one of the most difficult, yet potentially rewarding paths you can choose. It takes a skilled diplomat to negotiate transformation in an irritating coworker. Many EMS providers avoid these confrontations at all costs. For them, little problems build up until they become overwhelming. Did you know that the word postal is in the new edition of Webster’s Dictionary?

“If I don’t talk with John about cleaning up after himself around the station, I’ll forever feel like an unpaid maid/dishwasher. If I talk with the captain about John, he’ll probably resent me for not telling him directly. If I approach him honestly and directly, he may get mad, and I may get him to clean up once in a while.” Once you’ve talked yourself into the “change them” option, following this five-step recipe for confrontation will increase your chances of getting the results you crave.

Step 1: Encode the Message
It’s helpful to carefully craft your message before delivering it. This way, you can anticipate adverse reactions and modify what you are going to say. The most important thing about crafting your message is that you need to be clear that this is your problem and that you are enlisting their assistance in solving it. Now, you might be saying to yourself, “You must be nuts! How is it that her garlic, onion, Limburger cheese and stale coffee breath is my problem?” One of the truths about problem-solving is that it’s difficult, if not impossible, to solve a problem you don’t own.

The way to encode a message so that you own it is by using an “I” statement: “I (feeling) when you (describe situation) because my interpretation is (describe interpretation), and my request is (specific request).”

Your partner may have many different reactions to a message encoded with an “I” statement. They may apologize, become defensive, actively problem-solve, or make an excuse. On the other hand, if you encode the message with a “you” statement, it’s almost guaranteed to get a defensive response. How would you respond if your partner said, “You always leave french fries under the driver’s seat. I’m getting sick and tired of cleaning up after you. You’re an inconsiderate jerk!”? Conversely, if they said, “I feel frustrated when you leave french fries under the front seat of the ambulance because my interpretation is that you are not aware of my feelings, and my request is that you clean up after yourself so I won’t have to.” People respond better to an “I” statement because it’s a request for help rather than an attack.

Keep in mind that this crucial first step is not sugarcoating when what you really mean is so buried under sticky-sweet platitudes that no one could possibly get your real message. For example, “You are one of the best partners I’ve ever had, and it’s important that we maintain sanitary conditions for both us and our patients.” Nowhere in this statement is there anything about frustration, french fries or disregard of feelings. “I” statements are designed to be more direct and honest than other forms of direct confrontation.

Step 2: Drain The Emotional Bubble
Your opening statement is likely to cause an emotional reaction of some kind. I don’t know if you’ve ever tried to problem-solve with someone who’s “emotionally hijacked,” but your chances of successful resolution of the issue plummet if you don’t help them drain their emotions before you problem- solve.

The best way to deal with someone who’s emotionally charged is to listen deeply and empathetically. You need to listen with the honest intent to understand their perspective. Once you’ve heard them, paraphrase what they said and feed it back to them, along with an observation of how they are feeling. For example, if they say, “I’m not sure those were my french fries under the seat, but if they were, I sure don’t want you to think I’m a slob. I’ll try to do better.” You could reply, “You’re not sure if they were your fries, and you don’t want me to think badly of you.”

This validation of their emotions and perspective tends to drain the energy out of an emotionally charged situation. The basic rule is that anytime the person’s emotions fire up during the conversation, things will get better if you listen actively and empathetically. The biggest challenge is to resist the urge to explain, clarify or debate during this stage. Any of those common reactions will cause their emotional bubble to fill to the brim and get in the way of real problem-solving.

Step 3: Clarify & Dialogue
Once their emotions are drained, clarify the specific details about your concern and solicit their perspectives. The goal of this step is to engage in a dialogue. Dialogue comes from the Greek root word dialogos, which means “to pass through meaning.” In dialogue, people engage in a collaborative conversation that explores an issue or addresses a problem. Contrast it with the word discussion, which shares the same root as percussion and concussion. Discussion means to pound your ideas over someone else’s head.

During this dialogue, you’d want to talk about when you noticed the french fries, how often, what else you’ve done about it, how other people handle this issue, and what you’d like to see happen. You’d want to encourage them to talk about the issue, how they feel about you bringing this up, and their thoughts as to how to rectify the problem.
You’ll want to create a list of possible solutions to the problem. Keep in mind that people are much more likely to successfully implement solutions they’ve created themselves. No matter how smart you are, or how amazing your solutions, their chances of being successful are not as great as with the ones your partner comes up with on his or her own.

Step 4: Summarize & Agree
In this step, you summarize the details and perspectives on the issue, and agree on the best solution or solutions. Develop an action plan from your shared list of possible solutions. For example, our partner may have suggested that if she ate outside and got in the habit of checking under the seat every time she got out of the rig, it would solve the problem. You’ll want to make sure that you both understand and agree to the action plan, so there is no confusion or conflict on follow-up. Now it’s time to implement the solutions.

Step 5: Follow Up
It’s always important to schedule a time in the future to follow up and see how successful your action plan has been in addressing the problem. EMS providers tend to skip this step in the belief that once something’s been addressed, the problem is solved. Failing to follow up can set the stage for a major conflict in the future.

At your follow-up meeting, you’ll be at one of three places: total improvement, partial improvement or no improvement. If there is total improvement in the situation, it’s important to thank your partner and reinforce the improvement. “I haven’t seen a french fry or other trash under the seat or anywhere else in over a month. I can’t tell you how grateful I am that you’ve taken care of this.” This dramatically increases the chances that the improvement will be sustained for a long time. These difficult confrontations often have the surprise effect of improving the relationship you have with your partner. People tend to appreciate that you cared enough to deal with them honestly and directly.

If there is partial improvement, then you’ll want to acknowledge and reinforce the improvement and discuss plans to take it to the next level. Be sure to schedule another follow-up meeting to review progress toward total improvement.

If there is no improvement, you’ll want to explore why. Based on what you learn, you may want to activate one of the other solutions you discussed during the initial confrontation but didn’t try. You may want to choose one of the other options, like transferring to day shift.

In a few cases, dealing with problem partners requires help. Most often people will recruit a supervisor or manager to help with the situation. This is totally appropriate when dealing with issues like racism, sexual harassment, patient abuse or illegal activities.

One last thing: I hate to bring this up, but there is a chance—a very small chance, but a chance—that you are someone’s problem partner. If someone confronts you with something, take a deep breath, open your mind and work with him or her to create a solution that works for both of you. In the meantime, brush your teeth, quit eating food that causes gas, and dig your french fries out from under the front seat.

Mike Taigman has been a difficult partner several times in his career. Currently, he spends his time helping EMS leaders improve their effectiveness. Visit his website at www.emsleader.com.