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Thursday, February 12, 2015

The two types of healthcare workers: Over-functioning and Under-functioning

I have observed that there are two types of healthcare workers.  For the case of simplicity we will call them June and Tom.

June manages anxiety at work by over-functioning.  What this means is that when stress hits, she moves in quickly in an over-responsible fashion to take charge and fix the situation.  She walks fast from room to room and patient to patient, and gets her work done as fast as she can.  She takes charge, often telling people what to do  The higher the anxiety, the more she functions harder and harder, and the more she focuses on others who do not (in her eyes) fulfill their responsibilities or accomplish things.

People who are fond of June admire her competence, maturity, and reliability. Those who don't like her call her bossy, strict, overly assertive, and demanding.

Tom manages anxiety and stress by under-functioning.  What this means is that when stress hits, he slows down in a less responsible fashion.  The higher the anxiety, the more calm he becomes.  He tends to take his time, speak less, and gets his job done in a calm demeanor. He heeds orders, even those he doesn't agree with, and just does them to keep the peace. Rather than rushing from room to room in a panicked fashion, he steadily walks, rarely taking charge.

People who like Tom admire his warm, laid-back, charming, and relaxed style. Those who aren't fans of his think he should grow up and become more reliable and thoughtful toward others. They think he appears relaxed and uncaring, which is not the case at all. Chances are, even while he appears calm, he's already working on three things.

June might see in Tom a person who should grow up.  Tom might see in June a person who should calm down and relax.  Yet, as with marriages, the two opposing personality types are essential.

Toms are necessary in order to keep the peace and create an overall calm and peaceful work environment.  Yet too many Toms in one place may result in not enough stress to get all the work done.

Junes are necessary in order to take charge and get the work done in a timely manner.  Yet too many Junes in one place may result in too much stress, which might ultimately make it so even less work is done.

By working together, and with an appropriate combination of the two types of healthcare workers, an ideal environment can be created within a hospital setting.

The secret then is the two types of people learning to get along.  Obviously Tom's friends will side with him when there is a disagreement, and June's friends will side with her.  Yet through it all, there are rarely moments when either is truly at fault for conflict.

There is nothing wrong being a June or a Tom, as they can both be competent workers with many friends.  Yet they are different.

However, when the two get locked into extreme or polarized positions, they begin to operate at a cost to both self and other.  For example, say Tom gets a STAT page to the emergency room, and he calmly walks down.  When he greets the patient he calmly jokes with him as he is doing what the doctor ordered.

June, who happens to be a nurse in the room, thinks Tom is too calm and uncaring.  She sees his coolness as him not caring, and not working hard enough to get the work done.  So she says something to Tom.

Anxiety caused by June's "controlling" statement causes Tom to back away, and he becomes even calmer.  He says nothing to June, and continues to get his work done as he feels comfortable. He continues to jibe with his patient while he whistles while he works.

The patient likes the way June is taking the necessary actions to help him feel better, although he might agree that she is being a bit harsh to Tom.  He also likes Tom, because he makes him feel comfortable and easy in an otherwise stressful environment.

Many times Tom might approach the patient in a manner that June feels is late and too slow, although she says nothing.  Yet the tension in the room is so thick that anyone else in the room can feel it.  After the patient is fixed June will be on the phone calling Tom's supervisor to let her know how irresponsible and immature Tom was, and how worried she was about his influence on the patient.  June has all but lost her ability to focus on and relate to Tom's competence as a healthcare worker.

Tom, of course, did his full share to keep the intensity going.  Not only did he know exactly how to push June's buttons and keep her involved (like not stopping joking with the patient), but he was also highly reactive to June.  For example, when his boss came to him telling him that he was too relaxed in an urgent situation, Tom might say, "What do you want me to do, stop on the way to ER to wipe water on my face so I appear more stressed?"

June might want the two to get together to work out their differences.  Tom might see this as her trying to control him even more.  So the drama continues.

Ultimately June doesn't change and neither does Tom.  Despite any therapy or counseling that might take place, June will continue to over-function when under stress, and Tom to over-function.

Of course Tom and June may support each other, and learn to work together, for the benefit of the patient.  They may even be good friends under normal circumstances.  Yet there will be times when the two will not see eye to eye. That's just the way it is.

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