Learning to say NO

The successful road to a career in medicine is paved with mighty ambition. From the early undergraduate days, a pre-med student is challenged with the task of saying “yes” to everything—Yes, I can take those extra courses. Yes, I can be the president of this university club. Yes, I can add another extra-curricular activity to my busy schedule. Yes, I can do more in the same amount of time. Is this constant agreement to take on more tasks, more responsibility, and more work a character trait that is found more frequently in people applying to medical school, or is it a learned behaviour that is positively reinforced as we progress through the ranks of pre-med, to medical student, to resident, and beyond? Arriving at the end of my education journey and propelling myself quickly into a position in a new clinic, I have come to recognize that the propensity to always say “yes” is more of a learned behaviour than anything else. This learned behaviour, which was imperative for my success to this point in my life (was it really necessary?), has been feeling like more of a burden rather than a positive attribute that has brought me success. Read: Dr. Ginevra Mills: Reflections on gratitude and the unexpected Through a mutual professional acquaintance, I learned about a mindfulness-based stress reduction (MBSR) course and decided that I would take it. Initially I said “yes” to taking this course because there is a version of the course designed for people experiencing infertility and I wanted to know if it was something I would feel comfortable recommending to my patients. I figured, at the very least, I would learn some strategies to reduce stress in my everyday life. I was nervous however, as the time commitment—2.5 hours per week, plus “homework,” seemed an impossible task. In a very basic, almost Marie Kondo type of way, the MBSR course invited me to pay attention to the occurrences in my everyday life and, specifically, how my mind and body responded to them. I was quite taken aback by how much of my daily routine—whether home or work based—was contributing to my feelings of overwhelm. I was suddenly asking myself a very basic set of questions in relation to everything I was doing, especially if it was contributing to my sense of overwhelm: “Why am I doing this? Who told me that this needed to be done? Can I stop doing this or change how I do it?” Not surprisingly, the answers to these questions were almost always, “I’m doing this because I have to do it, because I told myself I have to do it, and I can change or stop what I do if I give myself permission to do so.” The first thing I did when I started my new position was install my work email address onto my iPhone mail client. Why did I do this? Because it’s what I’ve always done—my university email address, my residency and then my fellowship addresses were always there because I needed access to them all the time. But I quickly found that my work emails were continuing to come in after I left work and I was inclined to read them—most were from colleagues which were easy to triage if a reply was needed. However, some emails were from patients and I felt that I needed to respond to these emails before I could go to bed—and this was causing a significant amount of stress on myself and my family. When I stopped to ask myself why I was checking my emails in the evening, my answer was: “because that’s what I’ve always done.” When I reflected on the act more closely, I realized that it was ultimately my decision to do it and, therefore, it could be my decision to not do it. The next day I uninstalled the email from my iPhone and added an automatic response indicating that the email address is not regularly monitored on evenings and weekends. That was done 6 weeks ago and I haven’t looked back. A few weeks after finishing my fellowship I received an invitation from a high-impact journal in my field to peer review a submitted article. I felt that, in order to give back to the scientific community, I needed to accept the invitation. However, in the middle of starting up a new clinic, getting my kids set up in their schools and activities, and settling into my new roles and responsibilities, I begrudgingly took the time to review the article. I didn’t really want to do it in the first place, I had taken time away from other things that were more important to me at that time, and having it on my to-do list only added more stress to my already overwhelmed self. Once I submitted the reviews, I said I would not accept a review again unless I actually had time to do it. But a few weeks later, when another review invitation came though, I found myself hovering the mouse icon over the accept button . . . again. Before I clicked it, though, I asked myself the quick questions: “Why I am doing this? Who said I need to do it? What if I don’t do it?” The answers: “I’m not sure why I am doing this; I certainly don’t want to do it. No one said I need to, I just think I do. And, If I don’t do it, they will find someone else who will.” And just like that, I gave myself permission to say NO. Initially, I almost regretted that I didn’t say yes—there was this niggling sense of guilt—the thought that if I tried hard enough, I would have been able to fit it in somewhere. But that guilt quickly faded into oblivion when I realized that I had committed time to myself and the things that are most important to me. A few weeks after that, when another review invitation came through, it was easy for me to say NO even without much thought. I haven’t started saying no to every idea, opportunity, or task that is presented to me—this is far from the truth. However, I have gotten into the habit of putting a small bit of space between a task stimulus and my reaction. Now, instead of automatically saying yes and then wondering why I am always overwhelmed, exhausted, and seemly bogged down in never-ending tasks that bring little enjoyment or overall benefit to my life, I am better curating the tasks to which I commit. I may still not always have enough time to do them, or they might still be overwhelming, but if I’ve decided that there is a reason important to me that has made me say yes, and that, in itself, is less overwhelming. Finally, I’ve also learned that there is a myriad of choices between saying yes or no to something that comes up. Perhaps in the case of reviewing an article, the choices are binary in that moment. But in reality, I can be assured that there will be plenty of opportunities in the future to say yes, making the answer, “not now, but later.” In relation to my work email—it can easily be accessed from my computer or my iPhone browser, allowing me to check emails if I want to, and choose which ones I read and which ones wait. And for all the other, everyday instances where I might have set a precedent for always undertaking, I’ve given myself permission to stop and evaluate my reasoning, and this alone has allowed me a sense of freedom—a realization that I do have a choice in what I decide to do.

Learning to say NO

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Blog Author

Ginevra Mills

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