Help me be less irritable at work

I have a great job, as a primary care doc and medical director of a busy clinic. I work hard, but I wouldn’t say I’m overworked–maybe 50 hours a week. I’m also on call just about all the time, and I get called a lot but I rarely have to go in after hours.

The problem is that I have a hard time taking things in stride. There are lots of irritations through my day–difficult patients, staff asking me to do six things at once, charts that stack up. Every now and then, I’ll have a week or two when everything just seems to pile up, and every little thing gets on my last nerve. I’ve done everything I can to solve the problems that really get on my nerves, but only so much can be done.

The other problem is that once I get irritated, I am absolutely terrible at hiding it. I’m short with the staff, who for the most part are great people and hard workers. I have a hard time focusing on what I do (which is usually hard enough, with the ADHD), which means stuff backs up, giving me something else to be aggravated about. Rarely, I let my irritation show around patients or other visitors to the clinic, and then I feel like crap for being so unprofessional.

Has anyone else had this problem? What can I do about it?

Well, I have been told that picturing those customers/coworkers/people who annoy you as giant talking animals helps, but I never got the hang of it. Everytime I would try to picture a bitching customer as a giraffe, I would zone out and miss what they were saying. Might be worth a shot though.

I tend to get irritated when I’m feeling overwhelmed.

Realizing you may not be able to do much about your workload or the number of patients that must be seen each day, you could do little things that make your day better. Make your office quiet and dim and try to get in there to unwind a few times every day. Try to take longish lunches and relax during that time. Delegate to your managers as often as possible. And definitely take as many vacations as you can get away with- they seem to help the doctors that I work for when they’re feeling stressed.
I would say to get enough sleep, eat right, and don’t drink too much caffeine, as all of those things in the wrong balance can make Jack a cranky boy, but as a doctor, I assume you already know that.

As a professor, I started out having “people problems” earlier in my career. I could lose patience quickly when dealing with a student, particularly a student who was pushy or manipulative. I believe that I’ve conquered most of these problems. Obviously there are differences between my job and your job, but I think that the general approach I’ve developed should work in other jobs as well.

I have three principles for dealing with my work day-to-day: plan ahead, understand what other people want, and keep things in perspective. Now when it comes to applying those as specifics, my advice is:

  1. Keep either a PDA or an old-fashioned schedule planner with you. Plan out your weekly schedule, and leave some blocks of open time for dealing with the unexpected. This is particularly useful when someone else needs to have a long meeting with you, because you can give them a specific meeting time. If some says: “I need to talk to you,” responding: “I’m busy now, let’s arrange something later,” allows frustration to build up on their part. Saying, “I’m busy now, can you meet me in my office at 2:30 on Thursday,” is satisfactory; you’ve given them something specific, so they now know they won’t be put off repeatedly.
  2. Plan for encounters. When students come to talk to me, I can fit what they’ll be saying into a few categories. Roughly:
  • Wanting me to change a grade they’ve received.
  • Asking for extra time on an assignment.
  • Asking for help understand certain material, or on a certain problem.
  • Asking for assistance in studying for a test.
  • General complaining about how I’m running the class.

Since you mention “difficult patients”, I’d imagine that the difficulties you have with them fall into categories as well. The categories help because you can devise a policy for each category. For instance, in the first category, I break into two cases. If I made a genuine mistake while grading, I will change the grade. In any other circumstance (if it’s a judgement call, or if they want partial credit) I will not change the grade. Once I have the policy, I can plan according. In the first case, I’ll apologize for the error and promise to change the grade right away. In the second I’ll politely explain my grading, but I’ll be careful to avoid any possible ambiguity or appearance of uncertainty.

Once you have the plans, then carrying through an encounter with a difficult person is only a matter of following the script. Following the script is much easier than having to devise your response to a difficult person while talking to them.
3. An oldie but a goodie: count to ten before responding. In a heated situation, it works wonders for cooling your anger and avoiding saying something that you’ll regret.
4. For the really big fights, the ones where you and someone else are angry at each other for several days, and can’t even speak to each other without getting steamed, the key is perspective. Take some time by yourself, and ask yourself whether this issue will matter to anyone a year in the future. If not, then it’s not a big issue. With that in mind, it’s easier to accept a compromise.

I’ve been there. Getting irritated at trivial and not-so-trivial stuff, and then you’re dropping f-bombs in front of staff, getting in squabbles and generally acting like an ass. Suddenly it was like I was that screaming dickhead lawyer I always despised, throwing a shitfit because his printer wouldn’t work or the file got misplaced.

A weekly deep tissue massage of at least one hour worked wonders for me. I go every Friday night just after work.

Work out.

Seriously. Back when I was in (much) worse shape and working long hours and on call, I was irritable as all heck. Once I started working out, regularly, again and got my diet under control (cut down on junk food and sodas), my temperament improved markedly.

It was also very effective when I was irritated to take the time to go work out then. Not only did it get out my aggressions, but it kept me all pumped up and aggressive while lifting weights or doing laps or whatever.

I’d rather the people at the Y be wary of me, than my colleagues at work.

If you can just take 5 minutes to sit somewhere quiet and meditate, that can help unwind your spring a little bit. Set a timer, then spend a minute or two breathing deeply, scanning your body for tension and relaxing physically, then do actual mediation (thinking about nothing) or just visualize a calm, pleasant scene, as you prefer. Schedule this in for a specific time, not just a “do it if you have the chance” kind of thing, or you’ll never do it. Five minutes isn’t that long, and you’ll reap benefits in productivity by emerging from your mediation calm and clear-headed. It seems silly and a waste of time at first, but with a little practice, it’s very effective, and it’s even better if you have some other time (on your day off, in the morning before work, or in the evening) when you do a longer meditation session. It really is a skill that improves with practice. Once you’re good at it, something a simple as just standing in place, closing your eyes and taking three deep breaths can really drop your stress level through the floor.

And ditto what others have said about getting enough sleep and exercise.

Also, do you have a good system in place for assessing what work needs to be done at any given time? I don’t know about you, but I get really stressed when I keep thinking about all the stuff I need to do. Running through my mental to-do list just gets me more and more tense. Getting things out of my head and onto a piece of paper lets me assess realistically what needs to be done (it’s almost always less that I thought!) and stop that wasteful review cycle.

Replace your human patients with dogs/cats/birds/reptiles/etc and you have described me to a “T”.

What I do:

  1. Have a great time during your time off. I like to kayak, see bands, etc.

  2. Mood altering drugs. For all the negative publicity they receive, nothing beats a little ethanol/whatever at the end of a long day.

  3. Treat your employees great when times are good. My employees get little gifts, praise, hugs, etc when times are good. They know that when hectic times happen I may snap at them, but they have grown to accept it.

  4. Remember that 1% of your clients cause 99% of your problems. If someone is a complete PIA, I tell them to take their business elsewhere. This also helps employee morale, as the real PIAs are tough on everyone.

  5. Accept the fact that you are in a high stress position and do not be hard on yourself if you blow up every so often.

This is all IMHO. Remember, YMMV.

Two other things that I just thought of:

  1. Maintain a quality staff. I have receptionists/technicians/kennel people who are first rate. If they are not doing a good job, they are replaced. I could easily cut back on staff (and pay myself a little more) but a well staffed office makes a huge difference.

  2. Pay yourself well. I find I can swallow way more shit if the pot of gold is big enough. If this means raising fees, then go ahead.

Are these the irritations that put you over the top? The staff and other doctors should know that you’re ADD, and you can tell them straight up how it affects you. Our receptionist scans permits and files them electronically because I’m up front with that it’s just not a thing that’s ADD-friendly. And if you’re doing something, and someone wants to distract you with a new task, say, “I’m ADD, remember? Put it in the inbox.” In time they should learn what is important enough to interrupt you and what isn’t. You could also ask if they have something for you to do when you’re not engaged on something (I can imagine a lot of the time jobs are brought to you on an as-I-remember-to-tell-you basis, so maybe you can lower the number of these by asking).

Pretend you’re a bartender. You go to a busy bar, and the bartender takes a drink order and fills it, then moves on to the next. I’d be trying to take twenty orders at once and screwing them all up and blowing my top. When I have multiple pressing things going on, I try to remember the bartenders and do what they do.

Start keeping a journal and see if you can, over time, discern a pattern. If the bad weeks are too infrequent for this to be practicable, then they’re probably not actually problems! If they are, then maybe you can learn something insightful to help solve the problems. Offices ebb & flow, maybe learning the patterns will help make them easier to deal with. (Once I learned about some of the math behind stop-and-go traffic, I stopped being annoyed by it!) Is there something at work that sets you off, or is it something else that manifests itself as just generalized annoyance?

Here’s an idea from the book “Why Smart People Can be so Stupid.” In a series of experiments, some psychologists would leave a child alone in a room with a bowl of candy within sight. Some children were instructed that, if they had to think about the candy, to think of it like a painting of candy—as though they’re looking at a painting on the wall (of candy), rather than candy itself. Others, IIRC, were told to just think about it if they had to. (I think there were some where they were instructed to not think about it, but I can’t recall off hand.) What they found was that the kids who thought of the candy as a painting of candy went significantly longer before breaking down and stealing some. With that thought, maybe you can try thinking about a pile of files not as a pile of files that need to be put away, but as a painting of a pile of files. Who knows?

Sounds like my life, J.

Remember, you’re the professional, so it behooves you to lead by example. Not always easy to do.

I tell my staff to remember that I get grumpy, that it’s not personal, that they shouldn’t take it personally, and that when they see me getting irritable and annoyed, to tell me that I’m getting irritable and annoyed so I can recognize it and take steps.

The steps I usually take when I recognize what’s happening is taking perhaps a minute to go to my ‘happy place’ in my head. It generally has blue skies, a turquoise sea, and white sands, and the water is warm, and it’s inhabited only by me, and at times the Mrs, but only at my discretion.

It works for me, but it takes practice.

Then I also drag out my gratitude list, where I’m grateful I’m not dead, in prison (as an inmate), that I’ve a loving family, and that the day will be over in a few hours no matter what, and that I’ve got a challenging, decent-paying job.

I don’t like people. I have a very short temper, and I don’t suffer fools gladly. Unfortunately, I work with the public.

What I’ve found to be helpful is to force myself to think about it comedically. Whenever I’m forced to deal with an idiot, I write a Dope thread in my head, mocking them mercilessly. In this way, I’m forcring myself to keep a sense of humor about the situation and it doesn’t seem to bother me as badly.

Whenever someone’s pissing me off, I do the meanest thing you can do in that situation: become extra-sweet and polite. Nothing is more irritating to someone who’s trying to upset you than seeing you keep your poise, and what’s worse, redouble your efforts to be nice. Drives 'em batshit.

Are you serious or is this a joke? This would be the absolute worst thing I could ever imagine him doing. Human nature being what it is, it would an engraved open invitation for the people he works with (or has to discipline) to question his competency to do the job.

This can backfire. There are times when being pissed off is a legitimate strategy and you have severely limited your ability to go that way.

IME the kind of irritability you describe can be a warning symptom of depression (although certainly not necessarily). Keep in mind that IANAD, just occasionally depressed. While I would certainly not resort to drugs for this condition (i.e. irritability), keep a weather eye out for more debilitating symptoms. Should you have the misfortune to be prescribed one of the SSRI anti depressant drugs (Prozac et al) one positive effect that I experienced was the lifting of the veil of irritability.


Do people still give a shit whether someone is ADD? It’s a fact of life, and folks w/ ADD simply aren’t geared to some tasks. Explaining one’s weaknesses to co-workers so that burdens can be properly shifted is bad because…?

Let’s think of it this way. You work at a GP medical clinic as, say, a nurse. The doctor, the guy who runs the place, went to med school, and makes a lot more money than you do, cannot even keep two things in his brain for longer than two seconds, so he gets pissed and snaps at you. The guy is too incompetent to even deal with more than one thought at a time, and he’s treating patients?!

Juxtapose that with the following. You work at the med clinic, and the doctor is ADD. Yes, he’s really good as a doctor, but he’s distractable and very poor at task switching. So, if he’s doing something, you let him do it because not only is he unprepared to think about the interruption, but he’ll have trouble getting back to what he was doing.

If people don’t know you’re ADD, then you’re just a harebrained putz who can’t even handle the simplest stuff, like filling out forms. If they know you’re ADD, then the stuff you’re not good at don’t have to be included in the general assessment of your competence.

I should think that for a doctor, ADD would be a positive disability, since making odd connections from myriad sources would be helpful in diagnosing and treating patients. The downside is the paperwork & organizing. There’s a lot of paper in a medical office. Instead of telling the world you’re incompetent because you can’t handle a little paper & organizing, why not tell the world you’re competent but just not wired well for some tasks?

Well, part of the solution is not allowing yourself to be so irritable. We choose our thoughts, we choose our moods, and we choose our reactions to things. I would suggest working on your working zen - choose to let things go, rather than getting upset. Podkayne’s suggestion of meditation will help a lot with learning how to do this (I’m still working on my driving zen - I can choose my reactions to other drivers, and I’m still choosing anger way too often).

We live in a society where we are loathe to accept personal responsibility for anything, but I believe that with personal responsibilty comes great power - you have the power to make your day and your life what you want it to be - you’re not at the mercy of the vagaries of fortune.

A lot of people still do. Especially if their perception of someone with ADD is their cousin’s/neighbor’s/brother-in-law’s hyper and bratty little kid. I suspect that in real life the majority of people don’t know any adults who admit to having ADD. They probably do know a couple, but those people may not choose to tell them for privacy reasons or, as astro said, for fear of having their competency questioned.

Thanks for all the great advice. I did, by way of making a positive step, join up with our community gym last night, and worked out for the first time in ages. With any luck, I’ll work out some aggression and lose some weight at the same time. (Any tips on staying with a workout routine despite profound physical disinclination are very welcome.)

A psychologist I worked with during my residency said that it’s good to let your superiors know about ADHD up front, because if it comes up later it sounds like an excuse. My boss does know about this, and he’s been very willing to help me set up some efficiencies. I’ve been thinking about investing in a few sessions with an “ADHD coach”, if I could find one in my area; I think it would help me to learn some strategies and identify some trouble spots.

Congrats on joining the gym!

I find that to keep working out, the rut is my greatest ally, and habit is my best friend.

As much as your schedule allows, go at a set time on set days of the week.

Do not give yourself the option not to go; if you have options, you have to rely on your willpower to choose the right one. Why do you go? Because that’s just what you do on that day at that time. (I think it was Trunk who gave me that sage advice, and it kept me running through a whole hot, muggy summer.)

Never give yourself a day off as a “reward,” or allow yourself to skip as a “favor” to yourself when you’re feeling stressed out and overburdened. That just psychologically sets up going to the gym as a chore. Instead, remember that you go to the gym as a gift to yourself, so that you can have a healthier body and a clearer mind. Not to mention that if you allow yourself the option to skip means that every day you have to spend willpower not to take it.

If you’re tired, it’s okay to plan a light workout, but you must get your ass to the gym. Even a wimpy workout is better that sitting on the couch. (But this is really just a psychological gimmick: you trick yourself into going with the lure of an easy workout, but once you get moving, dollars do donuts you’ll start feeling better, and do your regularly planned workout.)

And remember every day you skip going to the gym might mean that your last workout was, in fact, your Last Workout. Ever. Don’t even take that first step toward total slackitude.

Other things that might help: Get together with a trainer and design a schedule with varied workouts. It will keep you thinking ahead and looking forward to what’s coming up on your next workout. This can go hand-in-hand with setting a concrete, achievable fitness goal with a specific deadline. It’s easier to motivate yourself to get to the gym if you view your next workout is an integral part of your plan to acheive your goal.

Good luck!

This is exactly what I do.

I have a coworker I’ve talked about before. She’s stupid. I have a friend I can send an icq message at any time during the day and describe the stupid thing she did (I call her HDA for “Helper Dumbass”) and he laughs and I can laugh and then it’s better. I’ve started viewing her as almost comic relief.