Recently, we as staff took note of how much SSVMS members really do. You make time in your already-hectic schedules to volunteer with charities, churches and synagogues, with the PTA or in your kids’ classrooms, and more. That’s before any family obligations or efforts to have a social life and is a lot for anyone just working a traditional 40-hour work week — a schedule many physicians would essentially consider a vacation.
Doctors are always in demand, but at some point too much is just, well, too much. But it’s often difficult to say no to requests for your time, whether it’s because it’s just naturally tough for you to do or because you don’t want to be seen as unwilling to participate in activities such as your child’s sports team or you know you can’t dedicate the time you should to a board position at a community organization.
Many of our members have been in the position or feeling obligated when asked or unable to moderate their desire to be involved in organizations they feel are important. That’s why SSVMS asked some of our members, who seem to have perfected the art of saying “no,” for advice on why to do it, when to do it and how to do it. Unfortunately, they all said no. So instead we reached out to the people staff knew would at least say “yes” to teaching their colleagues how to say “no.”
Each of these members has plenty to do before their extracurricular activities. Glennah Trochet, MD is the former Sacramento County public health officer, chair of the SSVMS Public and Environmental Health Committee, and served as Nevada County’s deputy health officer during the pandemic. Vanessa Walker, DO, is a pulmonologist, chief medical executive at Sutter Roseville Medical Center, and is the incoming SSVMS president. Adam Dougherty, MD, is an emergency physician with Sutter Medical Group and is the incoming SSVMS president-elect. The fourth, Serena Ly, is a third-year medical student at UC Davis.
These SSVMS members shared their experiences and philosophies to create a step-by-step guide to saying “no.”
There is a finite amount of time in the day, so it is important to start by taking stock of what you’ve already got going on in your life before adding to it. You might be surprised by how involved you already are and how much you are accomplishing.
“I think my high was 14 commitments. It was absolutely horrible,” Dr. Trochet said. “It was January 1999, I was the medical director of the County Clinics, I had two small children at home, and I was asked to take on the duties of health officer.” Her medical director position was already a full-time job, and so was parenting two children while her husband was in Berkeley most of the week. “Health officer was more than a full-time job, and there were a whole bunch of other committees and things I was responsible for.”
Dr. Dougherty said his commitments lined up differently than colleagues in other specialties because he works 11 to 12 shifts per month, which allows him to pursue other interests and challenges. “But even that can be difficult because going through COVID, my wife is a frontline worker as well and we were very much in survival mode, but took on a lot of things and got lost in the fog.”
Ly reminds herself that you can only do or learn so much, and it can’t come at the price of your health. “The utmost priority in your life is your wellbeing,” she says. “At a certain point, you have to set your limit. It’s an ongoing struggle of mine.”
Once you’ve assessed your existing commitments, it’s important to be honest with yourself about whether you really have the time or desire to take on an additional challenge. If it’s too time consuming or emotionally taxing, especially coming out of the COVID pandemic, it’s time to graciously say no. Don’t be afraid to be honest and cite your lack of time or generally feeling overwhelmed by your existing work and personal commitments as the reason you can’t fulfill the asker’s request.
If you’re still on the fence, the next step is to take a hard look at why you would accept adding more to your plate. It’s probably because it’s in support or an organization or activity you believe in, but it’s essential to know exactly what you would be getting into.
Get to know everything you can about the opportunity that’s being offered. Ask what the commitments are, what the expectations are, and determine how well you’d be able to execute it. Estimate what percentage of effort you’d be able to give to it and whether that’s acceptable to both you and the people offering the opportunity. Importantly, ask yourself: Why would I want to say yes?
“When I first started, I was in the ‘say yes to everything’ camp, because when you say yes and you’re seen as someone who’s willing to do things, then you’ll get more opportunities and that opens even more doors,” Dr. Walker said. “So even if it was something I wasn’t sure about, it could have been the key to something else.
“Then as my roles grew, I started having to divest. And I started dropping things. If it didn’t check one of two boxes: did I enjoy it, or was it something that very few other people had the expertise to do?”
Serena notices that she and many of her fellow students apply Dr. Walker’s initial strategy, but she agrees that it isn’t sustainable. “Eventually you’re going to burn out and you won’t be as productive,” she warned.
It might be a good cause or even a good career move, but that doesn’t make taking on more than you can handle to the detriment of your health or productivity a good move. If you can’t find a valid reason to accept that the benefits exceed the consequences, you have to say no.
When it isn’t possible to make an objective decision on your own, seek out the advice of a mentor or people you trust. They may have insight into the organization you’ve been asked to give your time to or may have experienced the pleasures or pitfalls from a similar decision.
Dr. Dougherty recommends asking family for their input because they might see things that you don’t or have an opinion or concerns you haven’t considered. Serena met her partner in medical school, so they both have an intimate understanding of the pressures and challenges they face and can make informed decisions together. Dr. Walker sees her parents frequently and her best friend every day to talk things out, but never makes an important decision without evaluating it with her husband.
“I know I’m the most supported person in the world,” she said.
Once you’ve evaluated the pros and cons thoroughly, you’ll make your decision. If saying yes isn’t the right thing for you, don’t put off saying no. Stringing it out not only puts more emotional pressure on you, it also limits the ability of the recipient of your decision to find someone else or alter plans. In other words, you’re not doing yourself or anyone else a favor by not responding promptly.
Dr. Walker and Dr. Trochet both say that “no” in and of itself is an answer, and you don’t have to feel a need to justify your decision to the person to whom you’re delivering the bad news. Each said their husbands’ experiences helped them learn that lesson.
“I would try to find some sort of excuse and take their feelings into account,” Dr. Walker explained. “My husband never got stuck in those situations and just said, ‘No.’ I thought he was being rude at first but I eventually saw that he’s just giving the answer. No is an answer. Don’t feel bad to say no.”
“My husband never got stuck in those situations and just said, ‘No.’ I thought he was being rude at first but I eventually saw that he’s just giving the answer. ‘No’ is an answer.
Dr. Trochet agrees. “Don’t make an excuse,” she said. “If the answer is no, you can just say no.”
Serena likes to be a little more gentle. “I definitely subscribe to the ‘compliment sandwich,’” she said. “I say that sounds like a great project, but I don’t have enough time to participate right now but you’re doing great things. But I do try to be direct in my answer because people appreciate that.”
Dr. Dougherty shared a bit of his internal struggle with it. “I was almost feeling guilty about saying no, but then I realized that people appreciated [the directness]. Everyone understands that there’s a lot of stuff going on so there’s no future resentment.”
As time goes on, things will inevitably change. Your availability will fluctuate, your responsibilities will fluctuate, your perspective will fluctuate. That’s why it is just as important to periodically reassess your current commitments as it is to think carefully about new opportunities. Dr. Dougherty said that when it’s time, you need to be able to close the chapter on your involvement with an organization. That may open the door to a new challenge.
“We’re all constantly changing, so understand that sometimes a yes will become a no or a no will become a yes,” he said. “Something might eventually feel like a chore.”
Dr. Walker reassesses based on her personal goals. “Set up a rubric and truly ask yourself what is important to you,” she suggests. “When you have clarity on that, you evaluate each of the things you’re doing and how it helps you reach those goals.”
Dr. Trochet said that those hectic days in 1999 were when she first had to say no. “I couldn’t be both the Director of County Clinics and the health officer, so I had to make a decision. And that’s how I became the health officer for Sacramento County.”
You can say no for all the right reasons, and that doesn’t mean there might not be regrets down the line, yet that can’t be part of the calculus when making your decision. Dr. Dougherty reiterated that it’s human nature to look at how things are versus how they could’ve been. Serena shared that she once had to turn down an opportunity she was craving because she simply couldn’t commit to it at that time, but it worked out in the end because she ended up being able to accept a couple of years later. Dr. Trochet, on the other hand, was committed to her choices.
“I don’t really live in regrets,” she said. “If I don’t get what I want, I’m able to convince myself that what I have is what I really want. It’s a gift in many ways.”
These are good lessons from people we know almost always say “yes,” so if they do say “no” you can be sure they've thought it through and mean it. Please use these techniques wisely (and with any group other than SSVMS!) to better take care of yourself.
Brandon J. Craig is communication and partnership coordinator at SSVMS. - bcraig@ssvms.org
