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Doctors at Work Podcast.

Episode #30

Assertiveness and how to say No.

Mat Daniel


In this episode, I talk about assertiveness, and how to say no. I explain why saying no is difficult, I outline ways of thinking that might help, and share two frameworks to say no in a socially acceptable way.

Podcast Transcript

Welcome to Doctors at Work. My name’s Mat Daniel and this podcast is about doctors’ careers. Today I’m exploring assertiveness and how to say no. Assertiveness for me is about standing up for your needs in a socially acceptable manner. And a classic example of assertiveness would be saying no. Of course, saying no is very difficult for many of us and there are a number of reasons why that might be.

I think a big one is about a need for approval. We all want, and we all need to be liked, and from a very young age, we’re conditioned to say yes, and we’re told that if we say no, then that’s a bad thing. And that means that when we say no, we then worry that other people won’t like us, or we worry what they think, that they think we’re selfish, or we worry it will lead to conflict.

Saying no then means we’re prioritizing ourselves instead of the person asking us. And that is seen as problematic if somewhere deep down we believe that we should always be pleasing other people. I think another issue for me when it comes to saying no, why it’s difficult is a need to be in control. We all want to be in control because we all, we want to know everything.

We want to be right, perfect. We want to know what’s going on. So, if we say no, that means we’re giving up the chance to show off our skills. And we may no longer know what’s going on. So, there might be opportunities at work that come up, whether that’s a project or something leadership related. And if you say yes, then you’re very much involved in all of that.

You’re in the know, you gain knowledge. And of course, with that comes power. But if you say no to some of those things, then that means that, of course, you then won’t know what’s going on. You won’t be in the centre of the activity, and that means giving up the control and giving up some of the power that you would have if you were intimately involved in whatever project is going on.

I think when it comes to saying no, there’s perhaps a couple of questions that you can ask to help you decide. The first question is, will saying no really change what this person thinks of me? If you’re worried that saying no will mean that somebody won’t like you, is that true? Do you have a track record with this person, which means that you can say no this time and that person won’t lose respect for you?

Or indeed, do you need this person to like you at all? Am I saying yes because I derive too much of my self-worth from how others see me? Clearly, if you’re saying yes because you just constantly need this external validation, then that’s not a great reason to be saying yes. And in relation to the second point about control, do you need to be in control?

Do you need to know everything? Do you really need to say yes so you can then show off how good you are? Perhaps saying no could create an opportunity for the person that’s asking for help to fix the problem for themselves. Or maybe if you say no this time, perhaps an opportunity arises from somebody who is maybe less experienced than you to develop their skills and to become an expert in the area.

For me, yes and no are two sides of the same coin. When we say yes to one thing, we’re saying no to another. Saying yes has consequences. If you say yes to yet another task, that means you’re saying no to leisure time. If you say yes to helping a friend, you’re saying no to running, gym, yoga, or meditation.

If you say yes to an unreasonable request for help, we’re taking away the opportunity for the requestor to learn to deal with the problem themselves. And if we say yes to yet another time, we’re saying no to others seeing us as an independent, rounded individual, capable of managing workload and work life balance.

And they will see us instead as a pushover that can be dumped on all the time. I think it’s important to consciously choose what you say yes to and what you say no to. And one of the things that can help you there for me would be about values because that can be a guide as to the kind of person you want to be and what you want to be doing and how you want to behave and how you want to treat others.

I guess another thing that can be helpful would be to have an idea where your career is going. Because if you’re good at what you do, which most of us are, then constantly we’ll be asked to do more and more, and you can’t possibly do everything. So, a really important thing for me would be, what’s that golden thread that’s running through your career?

And yes, there will be lots and lots of really useful things that one could do that would all be interesting, but if there’s a golden thread that runs through your career, that informs where your career is going, that ties all the other bits and pieces together, Then, knowing what that golden thread is, that can help you choose which things you say yes to and which things you say no to.

One of the problems is that often people say yes before they even think. And that’s a problem because you need to slow down, and you need to contemplate and make a conscious decision whether you say yes or no. Practicing mindfulness and meditation can be helpful there because that allows you to be more aware of your thoughts.

It means that you can analyse your thoughts, think about them rationally and make a decision, rather than just acting on instinct all the time. I hope you’re enjoying the show. If you like it, please click subscribe so you will be notified when new episodes come out. This podcast is part of my mission to help doctors create successful and meaningful careers.

You can be part of that mission too by forwarding this show to one person who you think might benefit from listening. Thank you. Now on with the show. Assertiveness means standing up for yourself and your views in a socially acceptable way. That’s not a negative thing. It’s not being bossy and it’s not being lazy.

All of us have views as to how things should be. And of course, often those things are different. What I want may be different to what you want. How I think the world should be will be different to how you think the world should be. And thank goodness for that. Because when it comes to being in the workplace, a diversity of views is celebrated.

We need to be respectful of each other’s views, because that brings a different opinion into how we work, and that means that our workplace is richer, and our teams are better, and we can do better things for our patient. It does also mean that every now and then, we do need to stand up for ourselves and for what we believe, and that needs to be done in a socially acceptable way.

When it comes to standing up for yourself and saying no, you could try the following strategy. Work through your feelings about saying no, and consciously choose to say no, even if that’s difficult, and even if it brings difficult thoughts and emotions. You can remind yourself what the costs of giving into other people’s demands are.

What would be the consequences of continuously prioritizing other people over many years, rather than yourself. You need to appreciate that you have a right to say no, to have rest, to see family, to walk the dog, to take a holiday etc. You could practice an assertiveness conversation, practice with some people around you.

But one of the things that you could do, you could start something very small. So just think of a very small thing to say no to, and you could do that first of all. Just take that small little step. You don’t have to start with saying no to a very big thing, to your very big boss. Just say no to something very small very little, and then we can build from there.

And go for win situations and for easy outcomes first. So, if you have a situation where it’s easy for you to say no, and there is a really good benefit to you saying no, and for the other person it’s not a big deal, then those are the kind of things that you could start with. And don’t worry about being perfect.

Focus on just doing something small, and then making progress from there onwards. A framework that I find quite useful So the first thing, when somebody asks you something, is to thank them. Then, you can make it clear that you recognize the importance of the task to them. So that’s about using empathy to make it clear that yes, you understand that this is something that’s really important to them.

You listened and you understood them. And you could also say that you consider a request a compliment, and then you can, at the end of that, politely decline. You don’t need to apologize, you don’t need to say sorry, you don’t need to negotiate or say you’re going to do it at some stage in the future.

There’s nothing to apologize for. You don’t need to use the word no, I mean you can say no, but for some people that’s a strong word and you might struggle with saying no. And above way is a way that you can decline, and that allows you to bring in different words. And a frank no at the beginning of an answer may be difficult for you to achieve, and indeed may offend some people.

So, you can try this framework, which perhaps is a little bit gentler, and hopefully will be easier for the person that is asking you, as well as for yourself. Let’s imagine that somebody asks me to write a clinical guideline. How might I use this framework to say no? So, I might say, thank you very much for asking me.

I can see that this guideline is really important, and that it really matters that this guideline is written. I’m flattered that you’ve asked me, and I’m impressed that you think that I have the skills and the knowledge in order to do a good job at that. So, thank you very much. I don’t have time to write the guideline at the moment.

I think it would be better if this task were allocated to somebody who has more time that they can devote to writing this guideline, as clearly this is a very important thing to do. Another way that you can be assertive comes from non-violent communication. And this stresses the importance of empathising with the other person, stating your own needs without getting carried away by emotions.

And that process goes as follows. So, the first thing would be to state what you observe. Then state how you feel in relation to what you observe. Next, you can state which of your needs or desires or values leads to those feelings. And you can then request action from the other person so that your needs can be met.

Let’s go back to the guideline example. Let’s imagine that somebody sends me an email and says that they have allocated me to write a guideline. And as it happens, I don’t think that it should be me doing that guideline. Perhaps there’s somebody else that’s better for that guideline. Or maybe I’ve written lots of guidelines already, and my perception is that it is other people’s turns to write some guidelines.

Maybe I don’t think that other people are pulling their weight. Of course, that’s my own opinion and that does make it problematic, but for the sake of this example, let’s work with that idea. So how might I apply this non-violent communication framework? I might say, thank you very much for asking.

I notice that I have been asked to do additional work, whereas other people in the team have not. That makes me feel that I’m being asked to do more than my fair share. For me, equal distribution at work and all of us pulling our weight, that really matters. Please may I ask that you have a look at how work is allocated to make sure that every person does their fair share.

Of course, this often then leads to negotiation, so you need to listen to what the other person is requesting as much as being aware of what your own needs are. Aim for consensus and look for win resolutions. And of course, remember that’s just my perception. It may be that I’m wrong and perhaps I’m not being asked to do anything more than my fair share.

So, when it comes to communication, it’s important that I take notice of the other person and that I listen and aim for compromise. Standing up for our own needs and saying no is always going to be difficult, whether that’s because we have this innate need for other people to like us or because we want to be in control.

But do remember that yes and no are two sides of the same coin. When you say yes to something, you say no to something else. I hope the two say no frameworks that I presented are useful and help you in your everyday work.

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