We all – well, most of us – try to be agreeable. It’s usually a better social lubricant to say
“yes” than “no.” It’s widely considered to
be better for your career to be the one who always says “yes” instead of being
the troublesome worker who often says “no.”
“Yes, dear” is a safer marital strategy than “no” or “not again.” But, like most conventional wisdoms, these
deserve to be challenged.
I’ve read several articles recently where “no” is the
suggested strategy, and I think there’s something there. Especially for healthcare.
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The first is a fun,
fascinating, possibly far-reaching article in Nature, “Why four
scientists spent a year saying no.” The authors are “a
group of mid-career environmental social scientists” who felt they were saying “yes”
to too many commitments. As a result, they
decided to not only be more deliberate about saying no but also to track
it. Their goal was to collectively
decline 100 work-related requests, which they hit in March 2022.
It's harder than you
might think; as the authors warn: “It involves rethinking priorities and
empowering ourselves and our colleagues to set boundaries.” They had to forget FOMO (fear of missing out)
and embrace JOMO (joy of missing out), in order to create more room for
intentional “yes.”
They offer four insights
about the learned skill of saying “no”:
· Tracking helped make “no” an
option;
· Say no more often ad to larger
asks;
· Saying no is emotional work;
· Practice makes “no” easier.
It’s often so tempting to
just say “yes,” but we’ve all only got so much time and energy. Sometimes “no” is the best answer.
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| "No." |
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Sometimes, though, the
saying “no” is not out loud; sometimes we say no by our actions. Which leads me to a new trend: “quiet
quitting.”
This is another TikTok trend,
started by one user (@zkchillin)
in July and quickly going viral. The
mainstream press is all over it, with articles in WSJ,
NYT,
NPR,
and CNN,
among others. Despite what it sounds
like, quiet quitting isn’t ghosting your employer, just walking away from your
job without a resignation or other declaration of leaving. In fact, it doesn’t involve quitting at all.
Quiet quitting rejects the notion that workers are
supposed to always try to go above and beyond.
It rejects the notion that work life is more important than life outside
work. It encourages people to say “no’ more at work inside of automatically saying
“yes” to requests that they take on more tasks or longer hours. It doesn’t mean doing the bare minimum
required to keep your job, but it insists on only doing the things the job
requires and pays them to do, during the hours they’re supposed to be doing
them.
It's a Gen Z thing. One 24 year-old TikToker, Zaid Khan, said:
“You’re quitting the idea of going above and
beyond. You’re no longer subscribing to the hustle-culture mentality that work
has to be your life.”
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| No, no, no. |
Healthcare as we know it would fall apart…as maybe it
should.
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Last but not least,
sometimes healthcare professionals should be saying “no” loud and clear, as
suggested in a NEJM Perspective by Matthew K. Wynia, M.D., M.P.H.: Professional
Civil Disobedience — Medical-Society Responsibilities after Dobbs
The core question, Dr. Wynia, posits, is: “What should
medical professionals do when a law requires them to harm a patient?” He is referring, of course, to restrictions
on medical practice imposed by various state abortion laws in the wake of the
Dobbs decision. He then asks the corollary
question: “When these laws directly and immediately threaten the health of
patients, should physicians collectively disobey them — that is, should they
engage in professional civil disobedience?”
Healthcare has plenty of organizations that collectively
claim to advocate for its constituents – the AMA, various specialty organizations,
the American Nurses Association, and so on. Cynically, these are often used to
argue to higher pay and/or better working conditions, rather than for the best
interests of patients. Sometimes they do
take moral stances, including (as Dr. Wynia points out) their concerns about
the implications of Dobbs. But actually
taking action, of threating work stoppages or boycotts? That’s a step they rarely take, and one Dr.
Wynia believes it is time for.
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| Credit: Francisco Kjolseth for The Salt Lake Tribune |
“Too often,” he laments, “organized medicine has
failed to fulfill its duty to protect patients when doing so required acting
against state authority.” Dr. Wynia
wonders: “How long could a dangerous state law survive if the medical
profession, as a whole, refused to be intimidated into harming patients, even
if such a refusal meant that many physicians might go to jail?”
Not long, I’d bet.
The danger, he warns, is that: “…when a society takes
a wrong turn and medical professionals go along, mistrust in medicine grows and
either social change must be driven by other groups or the society fails.”
In other words, time for the medical profession to say
no, at least when it comes to any restrictions that impact the best care of
their patients.
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Normally, I’m someone who is intrigued by new ideas,
who is excited about innovation, who wants to see change – all things that signal
saying “yes.” But saying “yes” to too
many things often effectively means implicitly saying no to most of them; we
can only do so much at once, we can only accept so much change at a time. Saying “no” more often, and more
strategically, allows us to focus on the things we must say “yes” to.
In healthcare, patients are too often forced to accept
“yes” to things they’d really like to say “no”
to.
Physicians and other healthcare professionals are often forced to agree
to work practices and restrictions that they know they should say “no” to. And both patients and healthcare professionals
are finding that legislators are acting in ways that are at odds with our best
interests.
Time to say “no.”
