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Mindful EM: Learning to Say No—and When to Say Yes

Hazan, Alberto MD; Haber, Jordana MD

doi: 10.1097/01.EEM.0000522216.84075.9b
Mindful EM

Dr. Hazanis an emergency physician with EmCare in Las Vegas and the author of the medical thriller Dr. Vigilante and the preteen urban fantasy series The League of Freaks. Find out more about his novels athttp://amzn.to/1Dug0iG. He is also a board member withwww.GivingMore.org. Follow him on Twitter @Dr_Vigilante. Dr. Haberis an emergency physician and the director of clinical education at University Medical Center in Las Vegas. She has a master's degree in medical education. Follow her on Twitter @JoJoHaber. Read their past articles athttp://bit.ly/EMN-MindfulEM.

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Most emergency physicians have hectic work and personal lives. We chose a career that doesn't cater to a 9-to-5, Monday-to-Friday schedule. Most of us go from days to nights and back again, at times feeling disoriented, sometimes jetlagged. We work weekdays, weekends, and holidays, and consider each a typical working day.

Amid this chaos, it's tough to keep track of our life outside work. Scheduling anything other than our shifts can feel like a major chore and be a source of anxiety. It is not uncommon to double-book or find ourselves overcommitted and wishing we had thought through our decision to pick up that extra shift for a colleague, be involved in that research project, or give that presentation.

Recently, we've turned to the literature for guidance. Greg McKeown, in his groundbreaking book, Essentialism: The Disciplined Pursuit of Less, advocates for a “less but better” philosophy for leading our lives. We know we can't do everything. If we try, we risk compromising quality in favor of quantity. Instead of saying yes to everything, we need to be mindful about every opportunity without being afraid to say no.

As Mr. McKeown describes it: “Essentialism is not about how to get more things done; it's about how to get the right things done. It doesn't mean just doing less for the sake of less either. It is about making the wisest possible investment of your time and energy in order to operate at our highest point of contribution by doing only what is essential.”

Our time is limited and precious. When we say yes to something, we are closing the door to future potential projects. The opposite is also true: When we are mindful about saying no, we allow ourselves the opportunity to take on projects or activities we truly care about. “We overvalue nonessentials like a nicer car or house, or even intangibles like the number of our followers on Twitter or the way we look in our Facebook photos,” Mr. McKeown wrote. “As a result, we neglect activities that are truly essential, like spending time with our loved ones, or nurturing our spirit, or taking care of our health.” He warns that saying yes to endeavors we aren't excited about or extending ourselves when overcommitted makes us miss potential opportunities to take on projects that do excite us.

So why are we so hesitant to say no?

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Going Big

We think twice about turning people down because of social awkwardness or pressure. This is especially true when a friend or a respected colleague asks us to give a lecture or cover a shift, even though we know we are stretched thin. But we say yes because we don't want to compromise our relationship with that individual. We don't want to be labeled as someone who doesn't help out, is lazy, or doesn't pull his weight. Many of us say yes not just because we fear social awkwardness or pressure but because of fear of missing out (FOMO). But saying yes to many good options makes us miss out on saying yes to the few great opportunities.

The solution is to have clarity about our priorities and pursue activities that align with them. Mr. McKeown pointed out that “essentialists see trade-offs as an inherent part of life, not as an inherently negative part of life. Instead of asking, ‘What do I have to give up?’ they ask, ‘What do I want to go big on?’” Essentialism is about making trade-offs, about having the insight to know which opportunities to take and the determination and willpower to say no in a graceful but firm way to activities that don't align with our goals.

How do we determine which opportunities to do? How can we turn people down gracefully without burning bridges?

Determining which projects to do is simple as long as you keep your priorities in mind. Apply this rule next time a colleague asks you to work a shift, attend a meeting, or give a lecture: If your gut feeling is an absolute desire to take on the project, say yes. For everything else, say no.

This philosophy allows us to identify our priorities, the few activities about which we are passionate, and to pour our hearts and souls into them. “The way of the Essentialist means living by design, not by default,” Mr. McKeown wrote. “Instead of making choices reactively, the Essentialist deliberately distinguishes the vital few from the trivial many, eliminates the nonessentials, and then removes obstacles so the essential things have clear, smooth passage. In other words, Essentialism is a disciplined, systematic approach for determining where our highest point of contribution lies, then making execution of those things almost effortless.”

Those who follow the essentialist lifestyle choose quality over quantity, allowing them to simplify their lives and placing their limited resources of time and energy into the handful of things they enjoy doing.

“What if we stopped celebrating being busy as a measurement of importance?” Mr. McKeown wondered. “What if instead we celebrated how much time we had spent listening, pondering, meditating, and enjoying time with the most important people in our lives? We can either make our choices deliberately or allow other people's agendas to control our lives.”

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