How physicians can learn to say no

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Your colleague asks you to take his clinic shift tomorrow. He has to take his daughter for medical tests and a consult.

You quickly spin through a list of to dos:

• Get someone else to pick up and stay with the children after school
• Prepare extra food tonight so there’s dinner tomorrow
• Cancel an appointment you have
• Give up your only afternoon off for months

You know this is important. You want to show you’re a team player. You’re exhausted….

What do you want to happen here?

• You want to say No. You are expected to say Yes.
• You want colleagues to see you as a helpful team player. You’d like to say No without disappointing - if not alienating - your peers
• You want good working relationships with colleagues AND to respect the boundaries that foster your wellbeing.

Pause before you answer, then…

• Be sure to give yourself a break: Tell him you’ll check your calendar and get back to him within the hour. This gives you a moment to pause and think
• Yeses create punishments as well as prizes. What part of who you are and what you care about do you say No to if you say Yes? How much does that matter to you?
  • Does it postpone a more important project?
  • Does it spoil a family relationship?
  • Does it stop the self-care your exhaustion is screaming for?
• When in the past have you said Yes and regretted it? What can you learn from that for this situation?
• When are you more likely to say Yes when you really want to say No? How does that affect this decision?

Do your answers persuade you that a No reflects your needs and values better than a Yes?

Now practice saying No [even if you decided yes here.]. Really. Most physicians find saying no – especially to colleagues – very difficult. Say your No aloud to yourself.

• Notice your intention, tone and posture. Keep it respectful.
• Practicing makes it easier and less negative.
• Use previous situations where you wish you’d said no to practice.

Say no to the specific ask and also tell them how you’ll help

• Tell your colleague:
  • Taking care of your daughter is very important.
  • I can’t take your clinic tomorrow. [Be clear and brief]
  • Offer something else that helps him solve his situation:
    • I’ll cover the next time you need to attend to your family. I can help better when I have time to make arrangements. Do you know now when the next medical appointment is?
      
      OR
    • I contacted [another colleague] who’ll take your clinic tomorrow. She needs a little time to get there. I’ll cover the first two patients to give her time to arrive, then she’ll take over.
• Contact the practice manager.
  • Suggest that the practice needs a way to cover clinics for physicians when there’s a family emergency. Most of the MDs and APNs have responsibility for either young children or aging parents. It’s particularly important for women MDs – who tend to be the primary caretake of children. So this is urgently needed to make the job doable for and retain women physicians.
  • Offer to work with the manager to propose solutions to the practice soon.

It’s (almost) a triple win:

A win for you and your values. At least a partial win for your colleague. A future win for your whole practice

First, why is saying No SO difficult?

• We’ve been taught since we were toddlers to say Yes. We learn fast that saying no meant trouble.
• We believe deeply that Yes wins friends. Saying No frustrates and displeases people. Saying Yes keeps the peace. Saying No causes conflict
• Physicians find it especially hard to say no. Physicians are healers. MDs are fixers by nature and by training. Saying No to colleagues – and you trulyunderstand the situation – feels like abandoning them….and not playing well together. A No can label you a traitor. For many the No causes guilt… then they overreact to the guilt
• Medicine’s hierarchy and deference for senior clinicians make it very risky for junior colleagues say No
• Physicians are also under huge pressure to do it ‘all’ and do it well. MDs in under-represented groups feel this more acutely: the culture is highly judgmental and often biased. In medicine, MDs worry that a No signals they can’t keep up professionally. They feel they’re not good enough.
• Women physicians often feel “like I had to always say YES to every task, opportunity, extra call, paper, manuscript, lecture, and all the other things I was asked to do. I wanted to advance in my field, be respected and make sure everyone knew I was serious about my job. Saying ‘no’ made me feel like I was disobeying; I was socialized as a woman to say yes. And, I should be grateful that I was even considered for extra work, even if it was unpaid work.” This physician says she and other women face this dilemma every single day.

What can you gain by saying No?

• Saying No is necessary to honor healthy boundaries. You preserve something important for yourself.
• People realize that you care about them when you say No AND Help-In-On-the-Way. You build the relationship by staying in, not just walking away.
• Women MDs in particular gain more control over their schedules, energy and priorities
• Deciding in favor of your values and priorities brings you closer to the best version of yourself. Consider both the prizes and punishments from the old habit of saying Yes when you really want to say No.

“What part of who I am today must I say no to so that I can say yes to the better version of myself?”
~ Michael Bungay Stanier

• Saying yes to what you want to focus on creates opportunities to add value, enhance your work and improve patient care. Physicians feel more satisfied and energetic in the work when decisions align with their values and priorities
• Future-forward thinking simultaneous to solving immediate problems is a critical leadership need now. Initiating the conversation for how to solve this common difficulty for everyone pays it forward for your whole practice.

TIPS:

• Sometimes the Ask is unclear, making it hard to decide. Clarify the request, the timing, needed resources, expected outcomes, etc. All before you say Yes or No. You show your concern for that colleague, and you assess your boundaries and priorities.
• Say No simply, briefly and clearly.
• Who else can help assess the need, the possible outcomes and potential costs?

Nance Goldstein, MDc, ACC, PhD, partners with physicians as a leadership coach to find ways through today’s tough times and enjoy medicine more.What have you tried when your providers and staff are unkind?
Email me – I’d like to know! Nance.goldstein@post.harvard.edu.