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Saying No

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We are achievers. We are competitors. We have conquered the medical education system and have successfully joined the ranks of ophthalmologists. We are capable, bright, dedicated and hard-working. We take care of people for a living, and many of us take care of family members at home.

However, we rarely turn our attention, energy and force of will toward taking care of ourselves.

We know that we are supposed to sleep enough, eat well, exercise, buckle our seat belts and follow a whole litany of self-care advice. We probably even know that we should have a technician check our own IOPs every now and then (when’s the last time you did that?).

And even though we know all of the things we should be doing for ourselves, we also know that many of us fall short in our efforts at self-care. There is no point in denying it or in feeling guilt over it. If you are a self-care slacker, you are not alone.

Why do we fail to do things for ourselves?
Everyone has a different reason for not doing things for themselves, but one common theme is, “I just don’t have time for myself.” We often feel pressure to serve the needs of patients, staff, family, colleagues and community. Physicians are certainly not alone in feeling these pressures, but, in some ways, we are particularly vulnerable to them.

By nature, we are high-achieving people with a strong sense of responsibility. We wouldn’t have gotten to where we are if that weren’t true. On top of that, we have been through the medical education process that loads us up with huge doses of ethical, moral and professional values that drive us to take even more responsibility for everything that we possibly can.

Over-commitment is a very common trap that young physicians can fall into, and it can lead to high stress and burn-out if it is not kept in check. Keeping our non-essential commitments under control is key to maintaining balance in our lives and in taking care of ourselves, so how do so many of us end up out of control and over-committed?

We are terrible at saying ‘No’
In order to take better care of ourselves, we need to get comfortable with the skill of saying “No.” This is a skill in that it requires practice and judgment to execute properly.

Most of us are very uncomfortable with refusing requests for our time or our efforts. Saying “No” goes against our natural inclination to be responsible and productive. Also, saying “Yes” to things feeds our ego — it means that we are needed and wanted and capable.

What we can learn about “No” is that we can still allow our egos to be fed, because the request still signifies that we are needed and wanted. We can also learn that the “No” does not signify that we are not capable. In fact, saying “No” at appropriate times signifies wisdom, not weakness. This is when our ability to show good, sound judgment comes into play.

How do we know when to say ‘No?’
One of the most difficult things to learn is when to say “No.” Again, everyone needs to define their limits for themselves. Knowing that it is OK to say “No,” though, is the first step toward developing this skill.

Many of us worry that if we say “No,” we will never be asked again, and we will become unwanted and unneeded. It is true that certain requests come along once and not again; however, most times there will be another invitation to write an article, give a talk, go to dinner, volunteer our time, sit on a committee, etc. The secret to remaining on the “ask” list lies in how the “No” is delivered.

First, if you wish to be asked again, say so. “I’m very sorry that I can’t help you this time, but please ask me again,” is one way to phrase your “No” to encourage future invitations.

Second, if possible, suggest an alternative person along with your “No.” This shows the requestor that you are truly interested in their activity or project.

Most importantly, once you decide against a request, give your “No” in a timely manner. It shows courtesy to decline a request as quickly as possible and not to leave the requestor hanging.

In the long run, saying “No” can help you better care for yourself. And that’s a big “Yes” for everyone.

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About the author: Jennifer H. Smith, MD, is the chairman of the Academy’s Young Ophthalmologist Committee. She is assistant professor of Ophthalmology at Northwestern University Feinberg School of Medicine.