How do you do your duty for people whose behavior you despise?

In My Humble Opinion
41

I work in a government office whose mandate is to help children and families. Many of our “clients” are, as you can imagine, very poor parents - neglectful, abusive, addicted to one substance or another …

I hate reading their files, I hate knowing about their history, I hate imagining what these people have put their children through.

But when I deal with them, whether it’s on the phone or in person, I remind myself that, in most cases, these people came from dysfunctional families themselves. THEY had addicted, abusive, neglectful, or mentally incompetent parents. Many of them are so damaged that even though their intentions might be to be good parents, their skills and abilities and lifelong issues have prevented them from having any idea of what a “good” parent is.

So although I find their choices and their actions absolutely reprehensible in some cases, I also understand they are part of a cycle, and it’s not my place to judge. I sometimes feel that I might be the only person they’ve dealt with that day who has treated them with respect, and that makes me feel good about myself and my job.

42

The fact is the world is not black and white. It is gray. You hav to learn when to look at the big picture and when to look at the little picture.

As a physican you are obligated to get your patient well (or take as good as care as you can) That is your ONLY job. You are not obligated to LIKE him in any way.

Suppose you were a surgeon and you transplanted a heart and the guy got well and then murdered his wife. You would be, in a way, helping to commit a murder. But that is in a large sense. If Hitler’s mom had an abortion that whole mess in the 40s would’ve likely been avoided too.

People often feel powerless, but they are not. You have to realize you can’t change the world, but you can change your piece of it.

When I find myself with situations like this, I simply ask myself “Can I live with this?” If I say yes, then I don’t worry about it. If I say “no,” then I make an attempt to change the situation.

Prisons need doctors and I imagine not a lot of physicans want to do that job, so you should ask yourself, “Do I like my job 51% of the time.” If yes, then just don’t let it bother you. If you say “no,” then you need to at least explore opportunities. The thing is as soon as you know you can get work elsewhere you feel better, even if you have no intention of leaving, because you’re not trapped.

43

As a physician, I’m sure you’ve found that most people in serious trouble tend to answer their own questions, and can recognize when you are doing the same. That’s where you did it: you behave in a certain way, sometimes counter to your emotional instincts, because your professional training obliges you to do so. Mostly, apparently, this isn’t a problem because your patients are usually willing to let you focus on their particular problem rather than on themselves. Your problem with this patient isn’t his crime, it is his refusal to sugarcoat it or allow you to ignore it. How often have you refused painkillers to someone when it would serve no theraputic purpose but merely allow them to exist more happily? They’ll have to get along without their crutch (drugs), and you’ll have to get along without yours (comfortable ignorance).

You say later in your post that this really isn’t a problem for you, that you just want to compare coping strategies. Don’t underestimate the one you’ve already got – you treat you patients with respect and dignity and dedication and the application of your best knowledge and judgment because you have promised to do so, and you are trusted to do so, and you’re taking money to do so, and so you have to.

44

Thanks to all for sharing their own coping strategies!

The accumulated wisdom shared here makes me feel even more strongly that I’m using a sound strategy of my own for this purpose.

45

Yes, I think your strategy is sound.

I’ve not had to deal with the type of people you work with, of course, but I had a former co-worker who was pretty toxic. At one point, she attacked me verbally in a meeting, and she actually lunged at me. It looked like she was going to smack me, and it was all I could do to not lay into her. I had to look away (keeping her in my peripheral vision in case she did try to hit me), and I was bristling. Another co-worker was looking to see what I’d do–it was that provoking.

What I did was to not engage the outrageous behavior and to stay professional with her. The co-worker who was with us helped, too, by firmly steering back to the topic of the meeting, which allowed me to get my thoughts back together. Later, I talked to friends, family, and my supervisor, both to vent, and to see if there were things I might be doing to provoke the outrage from her. My supervisor assured me it wasn’t me–that it was “just her personality.”

Not sure why she was allowed to continue working there (she had a long history of being nasty to people). But there she was, and I had no control over that. For a while, I found myself bringing the conflict with her home with me, and being stressed out about it ruined some evenings and weekends. When trying to let go of it with rational self-talk didn’t work, I finally found a way to divert myself from thinking about her. Every time I thought about her, I immediately made myself think “pink elephants” instead.

I spent many weeks thinking about pink elephants a lot. The thing is, it’s absurd and funny to spend so much time thinking about pink elephants, and it made me laugh. I’d start hearing that song from Dumbo in my mind and envision pink elephants marching around.

Finally, a day came when she launched another one of her attacks, and I literally laughed in her face because I finally saw her as absurd and not really my problem to fix. I realized that being immature and manipulative were the only tools she seemed to have to cope when she got in over her head at work–and she got in over her head a lot.

I also saw working with her as being similar to working with animals. You work with animals enough, and you are going to get stepped on, bitten and scratched sometimes. They simply do not have other ways to express fear or distress, or know how to work things out calmly and verbally if they feel cornered. So it’s on your shoulders to manage the relationship and not take it out on them. Instead, keep rewarding the desired behavior when it appears, don’t escalate or engage in their undesirable behaviors, and keep your eyes on the goal of whatever interaction you’re having with them and provide leadership toward that goal.

You’re basically working in a zoo full of tigers, QtM. Unlike tigers, it’s hard to find any nobility in human predators. But if you just see them as zoo tigers than need to be fed and cared for out of the minimal respect due any captive creature, then maybe it’s a little easier to disengage from your understandable personal distaste for their predatory habits. Maybe if you imagine yourself as Marlin Perkins or something, it will make you laugh, just as pink elephants made me laugh. :slight_smile:

46

Looks like I’m too late, Qadgop, but I wanted to say that every day you keep them alive increases the chances that the realization of who and what they are, and what they have done, will come on them suddenly in the night, in that long grey time before dawn, wake them up with a start and a vague feeling of dread… which slowly becomes a tidal wave of stark terror and abject self-loathing as they finally see how completely they have wasted the blessing of being alive, and that they are trapped like rats and utterly, inescapably alone.

I’m just sayin’.

47

I have several different coping mechanisms. One is the Real Nurse in my head, who is the snarkiest, most venomous person possible. Another is to vent to other friends who are nurses and can relate to my issues. And the last is I really try to keep work and home separate. Despite any number of neighbors and friends calling me to ask X health-related question, I tend to advertise that when I’m at home, I’m off duty. Most people respect that (unless it’s an emergency and then, 99/100 my advice is hang up on me and call 911). I also walk with my Nano and really look at the outdoors. I find it always helps me think these through, get a better perspective etc.

Bigger and broader than those things, though, is the fact that what you say is true: you only can do what you can do. It may very difficult to keep doing the same thing over and over again (getting up to fight another day etc), but the rewards usually come from the most unexpected places.

We work in healthcare. We see horrible things and truly devastated and maimed people, but we also see transcendence and courage. Somehow I don’t think the highs would come without the lows. :slight_smile:

48

Civil Guy mentioned Tolkien and I would point to another offering from Gandalf–one that I was heartened to see made it into the movie when it could so easily have been dropped:

I am not (a) God and I have no authority to pass ultimate judgment, so I simply concentrate on my duties and obligations and choose to ignore fantasies of doling out “justice.”

(This does not mean that I am never riled up. The managers whose every decision is based on the (short term) goals of their own departments to the ruin of the company or the clerk who walks off the job to “pay back” a superior he did not like, failing to comprehend or uncaring that it will be his co-workers, not the hated supervisor, who will have to spend extra time and effort cleaning up his mess), incite me to near-murderous rage, but being expected to put aside my feelings to act professionally does not gnaw at me that much.

Part of such choices–and here it would touch more closely on Moderating–is that there is a continuum of behavior and motivation. I might plainly see that a poster is being a jerk, while others might see the same behavior as not quite crossing the line. What gives me the right, (or the perfect vision), to know that the jerk line is here and not there?"
It is like one of the ongoing disputes in the death penalty argument. We should, (in one proposed scenario), still use the death penalty when we know beyond a shadow of a doubt who committed a murder. So how do we know? We already know that society has convicted and executed innocent people who were found guilty beyond a reasonable doubt in a court of law.
The only reasonable course, (from my perspective), is to simply follow the rules, despite whatever my gut tells me about such situations.

49

I’m a (HS) Science Teacher; although I don’t teach anyone who is currently incarcerated, but I have taught (and do teach) a couple who have been and, in all likelihood, will be again. There are also the ones I just don’t like. Most folks I can get along with; there’s a precious few I adore; there have been some I would cheer if the ground swallowed them up. Any teacher who tells you the cliched line that they’ve “loved 'em all” is lying.

I avoid the questions regarding more exothermic reactions (how to blow stuff up). And, as far as dealing with the kids I don’t like / trust, my job is to teach all of the kids, not just the ones I like. I deal with the behavior problems as best I can, and try to avoid thinking about why I don’t much like kid A or B. It’s a guarantee that some of my kids will see the inside of jail. All I can do is make sure that I am not the reason why they do.
ETA: After graduation each year, we have a “lock-in” celebration at a nearby college that runs until 6am for the new grads. At one, on the bus ride back after some kid had been trying to antagonize one of my colleagues, my buddy summarized it best as, “I am no longer paid to like you; you have to earn it now.”

50

As a police officer I deal with the not so nice all the time. There are various tricks that need to be used when dealing with them. Sometimes I have to be friendly. Sometimes I have to be stern. Sometimes I have to be an asshole. What keeps me from going apeshit on the 100th time I have been to a dirtbags house over something is pride. I have pride in myself and pride in a job well done. I do what needs to be done but I take pride in being professional. In any case when the other person gives me a chance I am respectful to them. I do this because it is the professional way to do things and also they tend to be less combative and respectful of me which makes my job easier. It also makes the next time I go there (there is always going to be a next time) easier. So basically I focus on what it means to me.

51

I’m pretty good at compartmentalization. And where that fails, I find meditation very helpful. A steady meditation routine will make a lot of stressful things clearer priority-wise, and more tolerable.

The example I always think of in this regard comes from a stint where I was volunteering in a soup kitchen in the inner city. Once a month, we would put together a hot evening meal for 75-100, serve it, and clean up/socialize with folks afterward.

One fellow was very friendly and outgoing. A lot of the other regulars liked him. In a group playing cards one evening, his name came up and a few of the men made note in a matter-of-fact manner that he was an ex-convict who had served time as a paedophile.

I have a long and unhappy childhood history of sexual abuse at the hands of a teacher starting age eight. The perpetrator has reappeared in my life numerous times along the span, always with disastrous results. This issue is my kryptonite and I was very tempted to stop volunteering then and there.

With a little reflection I came to the understanding that the point of my volunteering was the service itself, not to whom it was administered. I had not come to judge who was worthy or not worthy to be fed, after all. I believed that the service was important, and the performance of the duty to feed the hungry with dignity was the issue. With that, I was able to carry out the remainder of the year that I had committed to, and felt minimal cognitive dissonance in doing so.

52

““Many that live deserve death. And some that die deserve life. Can you give it to them? Then do not be too eager to deal out death in judgement. For even the very wise cannot see all ends.””

My husband works with inmates. (He’s an electrician for FDOC.) He finds it much simpler and easier to deal with just to try not to know what they’re in for. He came to this mind-set when we looked up an inmate online (don’t remember why) and found out he was in for something that sounded suspiciously like ephebophilia. (The FDOC’s site abreviates charges to the point where they’re very cryptic.)

53

I try to remember that I have a lot more similarities with the people you mention than differences.

People have reasons for doing what they do. A lot of bad behavior has a biological cause such as poor cognitive skills that limit judgment and impulse control issues. You’ve probably know that it’s a combination of nature and nuture.

I also try to remember all the advantages I’ve had in my life in terms of my upbringing and decent genes.

Anger and aggression are often used to mask a lot of fear and vulnerability. What’s that line that Jedis use? In this one there is a lot of fear, and fear leads to anger. Then anger turns into hate.

Empathy.

54

Like most doctors, there are particular groups of patients that push my buttons.

The smokers on oxygen, the morbdily obese diabetics, the alcoholics and junkies who continue to abuse their substances of choice…all of them I can cope with (up to a point). They have addictions and if I can remind myself to feel sorry for them, I can treat them.

The group that makes * me* angry…the “recreational” overdosers or half-hearted “suicidal” people. Not, I hasten to add, the truly suicidal or depressed people, or the ones with severe mental illness or alcohol problems who harm themselves.

Personally, I find it difficult to treat the repeat customers with minimally damaging attempts to “end it all” which are nothing of the sort. The ones who take small amounts of non lethal drugs whenever they have fight with their partner, or someone calls them out on their bad behaviour, or when they don’t get their own way, or just because it is Saturday and they are bored.

If you’ve taken 4 sleeping tablets and half a bottle of wine, then immediately called your mother to tell her to phone an ambulance because you’ve taken “a major overdose”, and have done EXACTLY THE SAME THING every 3 months for the last 5 years, you aren’t depressed or suicidal, you are a drama queen who uses an overdose as a power play.

Unfortunately, you also waste my rather valuable time and a bed in a hospital overnight which could better go to someone who is actually sick, rather than simply drunk and sleepy. The worst part for me is that nothing I can say or do will make you change your behaviour, because it gets you everything you want it to.

Every time I take your blood, examine you, hook you up to a cardiac monitor, spend time clerking you in, organise a psych referral I know will find nothing wrong, or put up some IV fluids to sober you up I validate your bad behaviour…and it sucks.

My coping mechanism is simply to remind myself over and over that this time they could have taken something dangerous, that this time they could really be depressed, that this time, if I’m not thorough, I’ll miss something on examination.
By being super thorough, as professional as possible and as emotionally switched off and as clinical as I can be, I can do it.

I’ll probably go and have a rant about it in private though…swearing helps enormously- the more creative the better.

55

I had a psychogy professor who said that there is no such thing as maladaptive behavior. All behaviors including those that are damaging and self-destructive have a purpose even if it is not obvious such as reducing anxiety or some other way to change, eliminate, or increase feelings.

People with manipulate behavior are difficult. It helps me to think that people who are manipulate are like that because they couldn’t get their needs met by more legitimate means. Also their manipulate behavior is often reinforced by their early care takers (unknowingly) because the parents may have just given into their kid’s demands out of exasperation or because the parents didn’t know they were being manipulated. Parents can be pretty clueless.

56

I swallow it (ignore/take deep breaths) until I can get in my car and get out to the lakeshore. There is something about staring out over a large body of water that always helps me put things back in perspective. Thankfully, I’ve been lucky enough to live close enough to one of the Great Lakes (or a lake, at minimum) that a medium-length drive will get me there without a problem. Additionally, I find driving in and of itself to be soothing. That combo will get me through about 98% of my problems.

For the rest, swallowing it until it passes is the only solution. Nothing bothers me for that long, and usually I can hold myself in check long enough for the feeling to fade enough for me to function again.

Of course, going someplace private and swearing helps pretty much always.

57

I don’t have the same high-level responsibilities as the OP, but early on in my career I did do some criminal defense work. There was no one I really despised, but some who were obviously career criminals and they weren’t going to change. I just reminded myself of my professional duty, and that I was just a small cog in the wheel of the justice machine, and if everyone else does their job too (i.e., the prosecution), then all should work out for the best.

But, I can see how the OP’s situation differs from mine - the OP can’t take comfort in the fact that there is someone on the other team trying to put the patient in the ground (or can he?).

58

My experience is nothing like yours or Oakminster’s. I teach secondary school, and often teach kids who have been convicted of reasonably serious crimes (though they’re still in mainstream schoolng).

One time a kid broke my wrist badly; while my arm was still in a cast, a friend of his told me he knew where I lived and it was my fault it had all gone bad and I was going to pay for it. I said ‘could you show me where the alliteration is in this line?’ and pointed to the text with my good arm.

I’ve also continued to teach other kids who’ve punched me unconscious in the corridor or who’ve told me they wanted to rape me. I make sure that these threats and assaults are known (to line managers, not my partner or friends), but otherwise it’s OK. It’s just the job - and for some reason I don’t feel all that threatened. I know what I have to deal with - and no kid has ever hit or threatened me twice.

Focusing on the job at hand (the routine for a task) is the key, I guess. The job is necessary, or even essential, no matter who you’re doing that job for.

It is different when teaching teenagers who might change, though. I’m not sure I could handle Oakminster’s old job.

That’s something I’ve always wondered about, actually - how people could live knowing that they’re defending people who are guilty of horrible crimes. But then, what if someone I loved was on trial? Wouldn’t I want them to have the best lawyer? Quite a few of those defendants must be innocent, surely? It’s a job that has to be done.

Same with a prison doctor. It would be a terrible society if we didn’t treat our prisoners humanely. Disregard the potentially innocent, or the families around them; it’s a societal good to treat even the most despicable prisoners better than they treated their victims so that there’s a high standard of treatment.

If necessary, you could even think of it as one in the eye: I’m better than you. And you really would be.

59

Also: I found that going part-time helped in many, many ways (more to do with the kids’ homelife than their own behaviour), because I couldn’t ‘switch off’ quickly enough to have a life of my own when working long hours.

Are part-time or shorter hours an option for you?

60

Actually no. Most of the folks I defended were guilty as hell.