What is ‘gray rocking?’ Should we embrace it or not?

Many pop psychologists and influencers on TikTok have recommended that one useful way to handle dealing with very aggressive and narcissistic people is to become as quiet and emotionless as a gray rock. In a 2024 New York Times piece (viewable with subscription), author Christina Caron explains, “if you adopt the qualities of a stone, becoming impassive and bland, then you will repel the argumentative, antagonistic people in your life who are itching for conflict.”

This approach has been bandied about so much that it has become a verb known as “gray rocking.” Gray rocking is viewed as a form of emotional disengagement that keeps one from getting deeper into the conflict with the aggressor. For those folks who thrive on the energy of confrontation, coming up against a stony-faced, unemotional person gets boring and they lose interest.

For those in the health or service industry, it is a form of deflection to avoid confrontation. For some reason, we run into people who are eager for the chance to abuse or demean anyone who is forbidden by the precepts of their job from returning fire. Some workers need to deflect the confrontation to keep their jobs.

Perhaps embracing gray rocking might work with a neighbor or a stranger on a subway car. For those of us locked into a professional doctor-patient or nurse-patient relationship with “difficult” people, we cannot just check out. For this reason, I don’t recommend gray rocking as a communication strategy for physicians.

We must honor our professional oaths and make the best of it. To help me (an emergency physician) and my colleagues do this more effectively and to help keep the situation in perspective, we need to change the way we think about “difficult” patients. Below are some tactics that I do recommend for physicians with challenging patients.

Learning their backstory

In 2022, I published a book, “Changing How We Think about Difficult Patients: A Guide for Physicians and Healthcare Professionals,” which covered the way our thoughts about a given event, person or circumstance can determine our feelings about it/them. Some people love a good snowstorm—others hate them. Our thoughts about the storm impact how we perceive and experience it. The same holds true for challenging people.

When elderly Mrs. Patterson always complains about how cold it is in the office, our thoughts about the situation can make it more difficult for us. If we think she should be grateful that we see her, or she should wear a sweater, or she should remember how we took good care of her when she was sick, we will become more frustrated than we need to.

When working with difficult patients, first, it helps us to try to understand where they are coming from. They fear what their injury or illness means and that can sometimes translate to frustration, aggression and violence. The parents of young children can behave in an awful fashion while facing the unknown and witnessing their child in pain or distress of any sort. The elderly woman who complains about everything might feel helpless.

Some challenging people are angry at their discomfort, their wait times, the unfairness they perceive in the system—all of it. They are stressed beyond their ability to handle it. They may lack the resources to get to a specialist or afford special medication. We do not know what their oppositional behavior is about unless we lean in and ask.

Perhaps they suffer with substance abuse disorder or alcoholism; or perhaps they are experiencing homelessness or have lost their health insurance benefits. Some resource assistance is only available if we know what the problems are.

Second, we can ask better questions about our patients that spark more curiosity and empathy on our part. What can we learn about an emphysema patient who keeps on smoking cigarettes? Is that man someone’s father or grandfather? My father developed emphysema after being introduced to cigarettes during his World War II military service. It was a very hard habit to kick.

The young man found face-down drunk near the local liquor store is somebody’s son. I have two sons and if they presented with challenging behavior, I would want them to be given the benefit of the doubt. I would want the doctors and nurses to hold their negative judgments and look for all the possible reasons that they might have some altered level of consciousness.

Signs to look out for

Is that person tired or hungry? All of us get grumpy without our most basic needs being met. Can we extend an act of kindness or give the patient some time to settle down and get themself together?

It would benefit us all to remember that most of our interactions with clients, patients and their families go quite well and folks are typically appreciative of the professionals who work in medical offices and emergency departments. Can we recall the sweet little smile of the toddler whose dose of acetaminophen or ibuprofen finally kicked in and they were no longer in pain? Those baby grins are the best.

Can we find some alternative solution or return visit to offer when a patient doesn’t want to go along with a plan? Can we find a generic medication or home exercise that might help with their illness? Or a daycare center that might help out a stressed family for a while?

Third, could we be wrong about the diagnosis? The treatment? The best consultant? The social services that are available? Yes, you could be wrong about something. Acknowledging that we, as the professionals, could be wrong about a diagnosis should cause us to be more curious and dig deeper for the cause of certain signs and symptoms. Perhaps the patient or the family are tired of treatment and are ready to take a comfort care or palliative approach. Has this even been discussed?

As impossible as it seems when a person presents with obstructive behavior and still needs help, the approach must be to lean in further. The tactic should not be to deflect like a gray rock, but to ask better questions and listen completely to the answers. Most of our patients and clients want more than just solutions. They want to be heard and understood. When they cool down, we must sit with them and acknowledge their grievances and concerns. An apology or acknowledgement that someone or something went wrong or is not up to par is an easy way to reconnect with challenging patients and offer an olive branch of detente.

Focusing on the positive

When nothing you try works with the challenging people, please remember this—that person was doing their best or the only thing they know how to do to protect themselves or their family.  Sometimes their best is terrible. Most of our interactions with co-workers, patients and families are pleasant and productive. Keep looking for those handshakes and moments when a distressed person turns the corner and starts to ask for a meal or a blanket or a better room. They may ask for a comb to do their hair. That means they are feeling a little better.

It would be lovely if all our interactions with people were respectful and courteous. Unfortunately, the real world is not all rainbows and unicorns prancing through the workplace. People swear, yell and insult when stressed out and unable to get their way. Every human has felt this way at one time or another. With this understanding in mind, we can move past the unpleasant interactions with people in our lives even when we can’t resort to gray rocking.

Related reading:

Did you work in the service industry before becoming a physician?

Anxiety, depression … is there an app for that?