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The Power of Saying 'No' in Medicine

— It can be a complete sentence

MedpageToday
A photo of a male physician at his desk with his palm out, saying no.

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Nope, nada, no gracias, non, rara -- they may sound different, but they all mean the same thing: no. In our world of instant messaging and immediate gratification, society seems to have lost the ability to unplug, unwind, and say no to unnecessary demands, which inevitably causes more inner distress.

The journey into my medical career was anything but easy. It was grueling and made me question myself -- was I going to make it? Was this career for me? I gave it my all -- literally -- my money, my blood, my sweat and tears, and most importantly, my time. Medicine is all-consuming, and the material and endless challenges that may present with patient care are something we were trained to stay on our toes for. It was important to go the extra mile because people's lives depended on us, digging deep and not stopping until we solved the problem. This was OK during acute challenges -- where my patients were faced with life-or-death situations, and as their healthcare provider, I and the rest of the team had to figure things out.

Unfortunately, somewhere along the way, I lost the ability to say no. I kept piling more on my plate, and frankly, I reached my breaking point. I wasn't able to juggle all my responsibilities because I didn't have enough bandwidth, and there were not enough hours in a day to take care of everything. Not to mention, I still needed to make time to care for myself and honor this precious gift called life.

I, like many other old-school souls who prided themselves on living off minimum sleep for days or weeks on end, reached a point of no return -- burnout. I was exhausted. The more I gave, the more it seemed people demanded of me. It was no longer the life-or-death situations I faced in residency or working in the emergency department; it was patients demanding on Friday afternoon at 4 p.m. that I fill their birth control pill because they were going away on the weekend, or patients irate because I didn't remind them that they needed to request medication refills. Frankly, it sounds ludicrous just thinking about the crazy, chaotic life I once lived.

Fortunately, for the most part, exhaustion and chronic stress are things of the past. I have learned to say no, and to say it with such eloquence and grace that I frankly am not so bothered about your response. As a physician, I know I work very hard and advocate for my patients, but I have also learned to empower them about their responsibilities to manage their health. After taking a break from practicing medicine to heal myself and find perspective, I was able to set up clear boundaries for my patients and for others. No longer will I work myself ragged -- not giving myself time to pause. I own my schedule, and I have systems to help me stay on time and organized.

In this transformative process, I discovered the power of saying no is not just about reclaiming personal time but also about fostering healthier relationships. Learning to say no is a journey towards self-discovery and self-preservation. It involves introspection, understanding your values, and recognizing your limits. The ability to articulate a firm no is, in essence, an expression of self-love.

As I embraced the concept of saying no, I found that it not only reduced my stress levels but also contributed to a positive shift in my overall well-being. The energy I once expended on over-committing to tasks and obligations has now been redirected toward activities that truly matter to me. I have cultivated a greater sense of balance in my life, allowing for both personal and professional fulfillment.

It is crucial to understand that saying no is not a sign of weakness; rather, it is a demonstration of strength and self-awareness. Setting boundaries is an essential component of maintaining mental and emotional health. When we say yes to everything, we inadvertently compromise our well-being, spreading ourselves thin and risking burnout.

In the realm of healthcare, where the demands are ceaseless and the stakes are high, learning to say no becomes a survival skill. Physicians and healthcare professionals often find themselves at the crossroads of numerous demands -- from patients, administrative tasks, and personal commitments. Without the ability to say no, the risk of succumbing to the pressures becomes overwhelming.

Through my own experiences and subsequent transformation, I have become an advocate for the importance of incorporating the power of no into medical education. Resilience and mental well-being should be integral components of the curriculum, preparing future healthcare professionals for the challenges they will undoubtedly face.

I have learned to communicate my concerns with others before they become a problem; however, if others refuse to make the necessary changes to create a peaceful environment, I remove myself from the situation.

If you, like many, are so used to being a people pleaser at the expense of your sanity, I empathize with you, as I know that it is not easy to turn that constant yes into a no. However, trust me, it gets easier over time. I encourage you to dig deep into the root causes of why you struggle to say no and to address those issues. "No" is a clear and straightforward way to communicate limits and boundaries. It leaves little room for misunderstanding or ambiguity, ensuring that your message is easily understood.

Saying no demonstrates assertiveness, which is crucial in maintaining personal and professional boundaries and helping you avoid over-commitment. As you start on the path to regaining control over your time and sanity, remember that no is a complete sentence, and your well-being depends on your ability to use it effectively.

In conclusion, the power of saying no extends far beyond a simple two-letter word. It's a transformative tool that allows you to reclaim your time, set boundaries, and prioritize what truly matters. Whether in your personal relationships, hobbies, or professional life, saying no is an empowering act that fosters a healthier and more intentional way of living. So, embrace the liberating strength of no and watch as it becomes a guiding force in creating a life that aligns with your truest self.

Tomi Mitchell, MD, is a family physician.

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