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Summary

If you want good health care, or to get what you're entitled to from a health insurer or from an employer, and/or to improve your relationships with friends and family, somebody has to be assertive and speak up about your needs, your understanding of what is happening, and your feelings. Asserting yourself has more chance of success if you keep in mind the other person's needs. When dealing with an entity such as a large insurance company, keep in mind that you are dealing with an individual person who also has feelings.

Being a "good patient" or a "good insured" doesn't always get you what you need. In the medical setting, there is always the possibility (perhaps unlikely, but still there), that you may be misdiagnosed or inadequately treated. In the insurance arena, you may not get what even your doctor believes you're entitled to. Being a "good employee" doesn't get you the accommodation you need, or even that the law may provide for you, to be able to do your work when symptoms crop up or you have to take time off for a treatment.

If you're reading this article, it is likely that being assertive for yourself can be difficult, especially in an arena where you might feel a loss for medical knowledge or regulatory familiarity. There are no magic bullets to change the situation. It's difficult to move into a zone that's not comfortable. But it can be done.

Once you start being assertive, it gets easier over time - although it may not seem like it in the beginning. However, it is important. For instance, studies show that patients get better health care and do better if they are assertive.

Following are tips that have worked for other people: 

To be sure you understand the current or future conversations, record them (with the permission of the other person).  

NOTE: If you are not comfortable being assertive on your own behalf, ask a friend, family member or a professional to do it for you.

Prepare Before The Meeting Or Phone Conversation.

Decide what you want.

Educate yourself about the subject, at least so you have a speaking knowledge of the matter under discussion.

  • The more you know about a subject, the less intimidating the other person is. This doesn't mean you have to become an expert.
  • The person you're dealing with may welcome and learn from your acquired knowledge and expression of it.

Be realistic. It doesn't help to ask people for things they are unable to give.

Think about what you want to say and the words that clearly express what you want. You can either write down the words that you want to memorize, or outline your ideas and leave room for improvisation. Experts generally suggest you start the discussion by saying something that shows your understanding of the other person's situation or feelings (it lets the person know you're not trying to pick a fight).

  • For example, if you're seeing a doctor, consider saying something like: "I understand that you are busy. However, I want to make sure you understand my symptoms and that I learn everything you can teach me about my condition and care."
  • "I am not a doctor or a medical expert and need you to explain what you've found and what you're suggesting in language I can understand."
  • Use facts or your personal feelings - not judgments. 

Think about what to say if you meet resistance to giving you what you need.

Rehearse.

  • Practice saying what you want with a friend or family member.
  • Ask him or her to pretend to be the other person who at times agrees with what you want, and at other times disagrees.
  • This is not play acting. You're not rehearsing a scene. You're rehearsing for real life.You don't have to pretend to be someone other than who you are. Just be yourself - that is, the more assertive version of yourself.

Keep In Mind How Serious The Consequences Can Be.

If you keep in mind that you're talking about your well being, your finances, your health and/or possibly your life, you will have encouragement to try harder.

Pretend You Are Speaking On Behalf Of Someone You Usually Care For Who Cannot Speak For Him Or Herself.

For example, if you have a child and are used to speaking up on the child's behalf, pretend to yourself that you are being assertive on behalf of your child instead of yourself. 

Be Relaxed And Calm. If You Are Uncomfortable Or Confused, Let The Other Person Know.

Think of the times you've heard someone speak in public who starts by stating how nervous they are. It's a simple mechanism to help release anxiety, to let the listener know you're having difficulty, and to request patience.

If the other person doesn't have the necessary time, find out when the two of you can speak again. Or perhaps the person has someone else in his or her office who can explain things more easily to non-experts such as you.

If you're asked to make a decision, and are still confused, ask how much time you have to make a decision. It's seldom required that a decision be made on the spot. It's perfectly acceptable to say something like: I wish to think about what we've said."  Then, take adequate time to educate yourself on the issues.  A proper understanding of the issues, will help you be assertive.  From knowledge comes strength.

Let The Other Person Know That Asserting Yourself Is Difficult, But That The Subject Is Important And You Appreciate His Or Her Consideration.

A statement such as this one lets the other person know you identify with his or her needs as well as your own.

Express your concern if you are afraid that by asserting yourself, you will offend or alienate the other person. Let the person know that you're not used to asserting yourself. Such a statement lets the other person know you're not intentionally trying to be difficult or demeaning. It also provides a safety valve in case you do unintentionally go too far because you're not used to asserting yourself.

Consider asking for constructive criticism about how you are asserting yourself. Perhaps the other person's point of view can help you assert yourself more constructively the next time.

Make The Other Person Human.

It is often easier to relate to someone as a person instead of relating to his or her title or function. Even the most imposing, frightening person, or the person with the biggest title such as President or King or Doctor, is a human being. We each have different ways of humanizing people.

Several ways that have worked for people:

  • Think of the person in a setting other than the one in which you're interacting.
  • Think about the fact that he or she sits on a toilet just like you do.

Be assertive, but not aggressive.

There can be a fine line between being assertive and aggressive.

To help stay assertive and not aggressive:

  • Be respectful - both in the words you use and your tone.
  • Stick to the facts.
  • Suppress anger. You may not like what is happening, but it is likely only part of an overall picture.

NOTE: The behavior on reality t.v. usually falls into the category of aggressive - not assertive. 

Be Persistent.

It is easy to accept a "no" answer. In fact, we may be programmed to accept a no if we grew up with such parental guidance as "Don't make a scene" and "Do anything to keep the peace." However, a "no" clearly doesn't get you what you need.

Keep in mind that there is a difference between being persistent and ignoring reality. If you have a question about where the line is, speak with a family member, friend or professional advisor that you trust. Sometimes even describing the situation out loud provides a different perspective.

If You Get Overwhelmed, Tell The Person And Set Another Appointment.

Setting another appointment gives you time to gather your thoughts and additional information.

Reward Yourself For Assertive Behavior.

Asserting yourself when you're not used to doing it is a courageous act. The reward doesn't have to be expensive. Maybe it's giving yourself a pat on your back, or a treat you usually don't allow yourself.

Consider Assertiveness Training.

If being assertive on your own is too difficult, consider seeking assertiveness training.

  • Speak with your local or national disease specific association for a recommendation.
  • Assertiveness training is also available on line. Search in your favorite search engine for local or online free or reasonable cost "assertive training courses." For instance,  www.williamslifeskills.com offsite linkhas a video/dvd and workbook for a fee.

Bring Support.

You can take someone to a meeting to help you be assertive (or to be assertive during those moments when you can't be). If you have a telephone conversation, it is easy (and generally inexpensive or free) to patch a third person into a call if he or she can't be on an extension or standing next to you.

If you are talking about a medical meeting, the person to go with you is known as a patient advocate. If you click on the link, you will learn about the role as well as how to choose the person.