The Power and Perfection of No

I’m writing this post from Japan, a beautiful and cultured country. Excited about encountering such a different culture, I’ve read several guidebooks that describe the sights as well as the people of Japan. For centuries, the Japanese were not allowed to leave the islands, and foreigners were not permitted to enter. This isolation led to arts and traditions that are prized throughout the world. It also allowed the development of a distinct culture – one that values honor, loyalty, and, above all, harmony. In order not to upset or insult others, the Japanese have evolved a manner of communication in which the word “no” is rarely used. If someone requests something you cannot do, you might say that their request is “difficult.” If they ask for an object you don’t have, you might pretend to look around and say that you’ll ask your supervisor. The Japanese understand this, as well as the body language that goes along with the discomfort of not being able to satisfy a request. So in the service of maintaining harmony, they drop their request. Many of us westerners also have difficulty saying, “no,” but our culture doesn’t help others understand our true meaning and we are then stuck with our “yes.”

Why do we do this?

We might not want to upset the person. We might not want them to dislike us. We might have a certain image of who we are – someone who gets things done, who others can count on, who doesn’t disappoint our families or friends. There are many reasons why we hear ourselves saying, “yes,” and then later wish we hadn’t said that.
One strategy that helps many of the compulsively over-committed is to simply respond, “Let me think about it and get back to you,” whenever someone makes a request of you. Like any habit, this takes time and repetition to install into your repertoire of ready responses. But once you say this, you can think over the request in the safety of your own space and consider the following questions:

Does this activity honor your values?
Steven Covey, in The 7 Habits of Highly Successful People, reminds us that it’s easy to say “no” when there’s a burning “yes” somewhere in our mind.
Do you have time for it?
Look at your calendar and schedule the time that you will need to put into the new project. If you don’t have time but want to say yes, what will you cut out in order to make the necessary time?
Is there another way to be involved that won’t take as much time?
If you can’t commit to attending every committee meeting or helping in the planning of the event, can you be involved in an advisory role?
Do you appreciate the concept, but have little interest in participating?
Expressing your appreciation for the efforts of those who are involved may itself be an important contribution, adding to the enthusiasm of the participants, even if you decline.

As busy healthcare providers, we have a lot on our plates. Saying yes to activities that don’t reflect our values or add quality to our lives is not an effective strategy for creating the lives we want. While harmony is important, communication is most efficient when we can learn to say yes when we mean yes and no when we mean no. And with our honesty, we will actually be the person who others can count on, the one who gets things done because we are truly invested and excited about them, and who doesn’t disappoint others by not following through on the commitments that we grudgingly accepted.
As a coach, I might challenge my over-committed clients to say “no” to three requests per day, just to become comfortable with it. Or I might ask them to reply to every request with the suggestion above, to take some time before getting back to the person. So I’m asking you…what do you really want to say “no” to?

About Helane Fronek

Over the past 28 years I have had a fascinating and fulfilling career in medicine, initially practicing as a general internist and then as a procedural specialist, caring for patients with vein disorders. As Assistant Clinical Professor of Medicine at UC- San Diego School of Medicine, I’m thrilled to be teaching medical students crucial communication skills along with many other aspects involved in the practice of medicine.
This entry was posted in effective communication in healthcare, honesty in medical care, physician coaching, physician communication, physician fulfillment, physician work life balance and tagged , . Bookmark the permalink.

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