It's Time for "No"

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. 

"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.”

No, no, no.

Healthcare, of course, shudders at the thought of quiet quitting.  What would happen if nurses wouldn’t work all those extra shifts?  What would have happened if doctors and other medical professionals had refused to see COVID-19 patients when PPE was lacking and no one quite knew how dangerous COVID was or how to treat it?  What would happen if primary care doctors stopped trying to fit 26 hours of work into a “normal” workday?  What would happen if physicians said it’s ridiculous that they have to spend two hours a day outside work hours on EHR tasks? 

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.

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.”