Q: I work in a medical office, where I have to take calls from incredibly difficult patients. Today, I had an awful time dealing with a verbally abusive, manipulative woman who said she had a medical emergency.

This patient insisted on seeing a particular doctor, refused to consider any others and wanted to come in only at a time when no appointments were available. She really got upset when I said that she was a noncompliant patient and that I would have to document her refusal of treatment.

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The woman managed to push all my buttons, and I really struggled trying to deal with her professionally. Do you have any suggestions?

A: First, ask the doctors in the office for guidance on handling patient demands. When should you work someone into an already-busy schedule? How do you respond to requests for specific physicians? These are not decisions that you should make independently, so you need guidelines.

Then you must learn to keep your cool when dealing with unpleasant people. Sick folks tend to be tired, worried and irritable. They want immediate help and are easily annoyed by office systems and procedures. Communicating with them requires a truckload of patience.

Lecturing the patient will make matters worse. For example, saying that you must "document her noncompliance" sounds punitive. Even if this is a legal requirement, you need a less threatening way to describe it.

In any business, employees who talk with angry customers must be calm, empathic and good at explanation. Saying "She pushed my buttons" really means "I wasn't able to control my emotions." But in this role, you can't succumb to your feelings. Frequent exasperation may be a clue that you're in the wrong job. Many capable people are not emotionally wired to deal with cranky callers day after day.

MARIE G. McINTYRE

OFFICE COACH

Q: Two weeks ago, I accepted a new position as an executive assistant. My manager initially seemed thrilled to have me on board, but now I sense that I'm not living up to her expectations.

My main problem is that there isn't much structure here. Random projects are thrown at me by my boss and others. Work is just dumped on my chair without explanation. I have no background in this business, so I'm not sure how to approach many of these tasks. What can I do?

A: You may be in a normal new-job learning curve. Or you and your manager may have diametrically opposed work styles. Or you may have landed in a completely dysfunctional environment. After only two weeks, the cause of your problem is hard to determine.

The first step toward solution is obvious, however: You and your boss need to talk. And, because she's been shirking her responsibility to get you up to speed, you'll have to take the initiative.

Ask what you're doing well and where you need to improve. Clarify any confusing job duties. Request help prioritizing the assignments coming at you from all directions. Then schedule regular feedback meetings to assess your progress.

Finally, remember to learn from your co-workers. Joining a new organization is like moving to a foreign country. The "natives" can help you decode the culture and avoid embarrassing blunders.

- Marie G. McIntyre is an Atlanta-based workplace coach. Her weekly column is syndicated by Knight Ridder/Tribune News Service. Send questions at www.yourofficecoach.com.