Sunday, March 24, 2019

Why Saying No is Hard

In retrospect, I'm a little surprised that it took me as long as it did to start protecting my time.  I've known from the very beginning of my training that, in order for my career to be sustainable, I need to have some time to recharge.  And I've done very well at protecting my time when it comes to vacations.  I've taken all of my allowed vacation days, and I've refused to do any work or studying when on vacation.  But when it comes to the day to day, I've let myself take on far more work than I can handle permanently without being miserable.  So why?

I spent nine years in medical training (4 years medical school, 3 years residency, and 2 years fellowship), and seven years in undergraduate/graduate school before that.  As a trainee, I got very limited choice about things.  My courses were mostly decided for me, someone else set my schedule, and saying no to things was almost never an option.  So I just sucked it up.  For years.  I suppressed my desire to sleep and eat healthy food and have strong relationships as much as I possibly could, and I survived in a sugar- and caffeine-fueled haze because I had to.

And then, I came out on the other side, and it took a while to occur to me that I was in charge for once.  Since starting my job, I've somewhat reflexively said yes to things, because that's simply what I've always done.  But I actually don't have to do that.  For once, I get to make the decisions. 

Denial (It'll Get Better Soon):
Whenever I look at my schedule, I think "Once <insert current thing that is taking up too much of my time> is over, I'll get a chance to catch up".  Except I never do.  Current thing gets replaced by next thing, and my schedule stays busy and overwhelming.  It has been like this for almost four years, and yet it is only now that I'm really waking up to the fact that my schedule will always be overwhelming unless I deliberately take steps to slow down.

I really have absolutely zero to complain about when it comes to my money.  I am paid very well, and since I started working in 2015, I've paid off my six-figure student line of credit and accumulated almost 1/3 of what I need to retire.  I am doing great, and I know there are a lot of people who would be very happy to swap financial situations with me.  I recognize how fortunate I am financially, and I am incredibly grateful for that.

And yet...I still worry.  What will happen if I become disabled*?  If my province radically cuts healthcare funding and my job changes or disappears?  If I burn out and am no longer able to work?

The worry drives me to accumulate.  To build up my cash savings and my investments as protection against all of the uncertainty of life.  Working less means earning less, and while it would still be more than enough, it feels scary to someone who is as security-focused as I am.

Other people do more than me.  They see more patients, do (waaaay) more research, and have more administrative responsibilities.  Lots of them have spouses and/or children, so they have a whole second set of duties to take care of when they go home.  And when I look at these people, I wonder "Why am I complaining about my much emptier schedule?  Why can't I do as much as they do without complaining so much?"

It is hard to accept that I simply can't.  Whether it's because of my anxiety, or being an introvert, or my perfectionism, or some combination of that fabulous trifecta, I simply cannot do as much as other people do.  And more importantly, I don't want to.  I want to not panic if I have to add an extra patient to a clinic because of an emergency.  I want to sleep through the night without experiencing anxiety-induced insomnia.  I want to have unstructured time at home to just breathe and exist, without having to constantly run through my to-do list in my head.

I want to be happy, at least most of the time.

What makes it hard for you to say no?

*I have some, but not enough, disability insurance right now.  This is one of those "important but not urgent" things that I've been putting off for too long.


  1. Everything you've said rings so true, even though I'm still finishing up residency. The shame bit, especially.

    I'll add to the list by saying that I think I fancy that I'm more effective and important than I actually am. I say yes because I fancy that I'm the only one who can do the thing I'm being asked to do. Increasingly, I'm recognising that other people can do most of the things I'm asked to do at least as well as I can. Setting aside the ego has helped a lot, but frankly I still overcommit.

    I also, like...really want to be liked, and that can be a powerful motivator.

    1. So nice to hear from you! And excited that you're close to being done.

      Shame is such a huge one in medicine, and it's perpetuated by the silence that doctors live with. I'm constantly the person talking about mental health, burnout, overwhelm, etc. because I want to try to change a bit of the culture to let people talk about how hard things often are.

      It's good to recognize that you're not the only one who can do things. Being part of a small group, I actually have the opposite problem - sometimes I am the only one who can do things. So a lot of my guilt comes from knowing that if I don't do things, they may simply not get done. Which is tough.

  2. What I see frequently in your writing is a concern about being disabled. Certainly, don't share more than you're comfortable, but is this an expectation of some sort? Sounds like you still push yourself really hard; would you be able to cut back some on working and maintain a better quality of life if you slowed down on reaching your goals?

    I also have a hard time saying no. I want to be useful and appreciated. But I'm slowly learning that I'm often not appreciated enough, or people expect me to continue doing things and stop feeling grateful. So I'm slowly trying to say no a little more, but I'm also looking around at other job options to see if I can find a better fit where not so much is expected from me.

  3. I think I've shared before that my tendency to overload myself professionally in the past stems from a similar worry about being unable to work in the future, and that it's taken a very long time to get myself to change my approach to work and money. I'm also always fighting a feeling of failure / falling behind, at least a little bit because I'm aware that we desperately need a better community of support here and it requires socializing to build those bonds. It's tough forcing myself to take on that extra work, even if we do it as a team, because it means I HAVE to say no to the other things.

    This weekend is a case in point for what happens when I don't say no like I should. I should have scheduled yesterday's dinner for two weeks from now and I'm paying a very heavy physical price for that mistake. :/

  4. I constantly worry about falling behind or not being "good enough" at my job. CONSTANTLY. I've tried really hard this year to prioritize my personal wellbeing and to get regular exercise and sleep, but... there's always something I could be doing better at. I curse myself for needing 8.5h of sleep per night. If only I was one of those short sleepers, life would be perfect, right? But it probably wouldn't be.

    And now I'm going to go study for my boards for 20 minutes before I get ready for bed. :-P

    Maybe pick some things that YOU WANT to say yes to, and then say no to all other other things, rather than automatically saying yes just because you want to be nice and helpful to someone else? The struggle is real.

  5. So glad that you are back and that you wrote about this so honestly. Very sorry to hear that it was prompted by the body saying no.

    I definitely feel the shame part... how are other people doing so much more than me? Especially in the world of medicine and especially when I don't have kids!
    This has gotten better in the last few years, I think for a combination of reasons... which may or may not be helpful to you.
    1. I have some friends/colleagues where I feel like I've been able to see up close and personal the reality of "doing everything" and that has made me realize why that's not for me.
    i) the friend who is an uber dedicated physician and involved in 45 other things but is barely sleeping, not very happy and has to schedule a catch up coffee 2 months out.
    ii) colleagues whose names are on everything related to advocacy, research, workshops etc in addition to having a clinical practice... but now that I'm in some of those groups with them I realize they are not really involved, i.e. don't actually attend the meetings, respond to the emails or participate meaningfully in half the groups.
    iii) the friend that does basically do it all, but the tradeoff is zero spontaneity or diversion from the schedule (and probably others I don't know about).

    2. I think it was when I read the book Trauma Stewardship (highly recommend if you haven't read) where it talked about really getting down to your purpose. That and a few other things helped me to focus on what I actually care about, which has made it easier to say no to the things I don't. Mentoring a new NP or nurse? Yes. Getting involved in a 1st year students random and ill-informed project? No. Direct patient focused things? Yes. Being involved in program planning at work? Yes. Being involved in anything to do with research or very detail oriented logisitics like med management? No. Advocacy I still struggle with the right amount or where to direct my energies.

    3. Major moment when I finished my resume at the end of NP school (I had worked in a number of really cool jobs before that). I realized I could not remember much about the actual day to day projects/things I stressed like crazy about and could really only remember the friends I made/people I worked with. Major lightbulb. I still work hard and care about my patients but it made me think a lot about what would actually matter to me if I was sick/dying/90.

    Anyways, way to go with recognizing this and more power to you as you say fuck no! We are cheering for you.

  6. "It is hard to accept that I simply can't. Whether it's because of my anxiety, or being an introvert, or my perfectionism, or some combination of that fabulous trifecta, I simply cannot do as much as other people do. And more importantly, I don't want to. ... I want to sleep through the night without experiencing anxiety-induced insomnia. I want to have unstructured time at home to just breathe and exist, without having to constantly run through my to-do list in my head. I want to be happy, at least most of the time."

    Yes! THIS! I could have written this myself. You're not alone.

    Omg. It takes me all weekend to recover from the work week. RECOVER. I'm so stressed and drained that it's not until Sunday night that I start to feel ready for the weekend. But the weekend is already over and instead I have the Sunday night blues thinking about work.