How Physicians Can Learn to Say No at Home, at Practice


Competing demands often make it difficult to draw boundaries between home and work for busy physicians. It helps to have a plan.

Yes or no? That is a question I too often find myself faced with. You'd think that after many, many opportunities to practice saying no, that I'd be a whole lot better at it. However, it still is a challenge for me, like it is for many people. I think part of the reason saying no is so challenging is because we secretly fear that saying no too often will guarantee that we stop getting asked at all. As a result, we have a tendency to overcommit and overschedule.

Recently, I was asked to attend an important meeting on my usual day off. Unfortunately, this particular day happens to fall during my kids' spring break and was the one day I had scheduled to spend with them while they're off from school. I agonized over this choice. Not only do I hate to disappoint my kids (and myself) by giving up a day together, but I also know I will feel guilty whether I say yes or no.

I don't mind extra requests from work, other than the choice it forces me to make. Is the work commitment or the home commitment more important? Which matters more? Which should I choose? Even when I finally come to a conclusion, I find it difficult to find peace with my decision because, inevitably, I continue to question whether I made the right choice.

In the case of my work meeting, I reviewed my work schedule for the past few months to decide if the balance was more in favor of work or home. Next, I queried the meeting organizer about exactly how important the meeting will be. I considered and ultimately decided to share with the organizer why the decision to attend was so challenging.  I discussed it with my husband, which wasn't very helpful as he advised me to "do what you need to do." I considered the long-term effect on my kids. Would this be another time that they would remember that mom wasn't around when they were off from school, or would my presence (or absence) go unnoticed in the grand scheme of things?

Ultimately, I decided to attend the meeting and try to carve out some "compensatory time" elsewhere in my schedule to spend with my family. Making this one decision, unfortunately, doesn't make the next one any easier, as it will compel me to start the whole process over again - weighing the balance of time and importance to both work and family - and making my best judgment as to whether work or family gets prioritized.

I don't know that there is an easy way around this conflict. I've tried tricks over the years, but still seem to be as overcommitted as ever.  One thing that has helped is to remember that many of the things I agree to do are things I genuinely enjoy doing. Once I get beyond the guilt of not being at home, I usually get excited about whatever I am involved in. The second thing that could help more (if I was better at it) is to carefully consider what kind of mom and what kind of doctor I want to be. The more I struggle with my role, the more I struggle with saying no.

So for the next request, I will need to be better prepared to know whether the request is likely to energize me and whether it aligns with my personal or professional goals.

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