Setting boundaries: How to say no — and when to say yes

As we approach the holidays, we often find ourselves feeling overwhelmed and overcommitted. ‘Tis the season to start setting boundaries, and it all starts with learning how to say ‘no.’

This is easier said than done, especially for physicians. We tend to be notorious people-pleasers who find ourselves saying ‘yes’ to things we don’t want to do because we hate to disappoint others or because we dread conflict. Other times we hesitate to say ‘no’ because we fear losing job or status, or out of fear missing out on opportunities. And of course, sometimes we agree to take on more than we should because of a superhuman view of ourselves that we are the ‘only one’ who can do the job, or that we should be able to handle more than anyone else.

According to psychologist Steven Cohen, PsyD, when we don’t know how to say no (or when we say yes for the wrong reasons), we end up resentful and angry, which takes a toll on our psyche. Cohen says that the first step to taking back control of your decisions is to stop saying ‘yes’ automatically. Instead, pause before answering to ask yourself one simple question: What are my motivations for agreeing to this request?

Consider your motivations

Start by assessing your rationale for agreeing to extra demands on your time and energy. One of the best questions to ask yourself is whether you are being offered an opportunity that will benefit you or add value to your life. Consider whether the task aligns with your future goals or is merely another responsibility added to your plate.

For example, imagine that your employer has asked you to sit on a newly formed work committee. If the committee involves issues that are important to you personally, or you think will lead to future desired opportunities in leadership, then it may be reasonable to agree to commit to the project. On the other hand, if you suspect that this committee is unlikely to accomplish any meaningful goals or benefit your life in any significant way, then respectfully declining is in your better interest.

One common reason that physicians bite off more than we can chew is an inflated sense of self-importance. The truth is that no one is indispensable, no matter how important or good at their job. It is a painful truth that when we are long gone, someone else will see our patients and chair our committees. Ask yourself if you are only agreeing because of ego or anxiety that you are the “only” person who can do the job (or do the job right). which compels us to take on every offer and opportunity that presents itself until we are so burned out that we can’t manage our regular responsibilities or take care of ourselves.

Overcoming fear

It’s also important to yourself whether you are saying ‘yes’ because of fear—are you afraid that if you say no, you will lose your job or the respect of others? Examine these anxieties and fears and determine if they are realistic or illogical.

For example, you may find yourself thinking, “If I don’t agree to serve on this committee, I’ll probably get fired.” According to Cohen, this is the type of automatic negative thought that is ripe for self-examination and cognitive reframing. Challenge your belief by asking yourself, “do I have any proof that I’ll get fired if I decline this opportunity? Is this a logical conclusion?” If the answer is no, practice reframing by thinking in a more positive way, like, “My practice is busy and successful, and I already participate in other committees. It’s likely that administration will understand that I can’t take on any additional workload.

Another common fear is fear of missing out. We often agree to every offer because we are afraid that if we say no, we will stop being asked. Sometimes this is true—but it may not necessarily be a bad thing.We need to remind ourselves that it’s far better to seek out opportunities of interest, rather than getting sucked into more and more low value activities that come with saying ‘yes’ to every invitation.

How to say ‘no’

Before responding to opportunities, make sure to take the time to consider your decision—you don’t have to respond immediately. Avoid answering when you are too busy or distracted to make a good decision. Be aware of your surroundings and note that those around you may influence your decision.For example, if an administrator is asking you to do something in front of your peers, you may feel pressured to say yes. Instead of answering directly, ask for time to consider the request and answer after you have had time to determine whether it makes sense to agree. “It’s best to name a specific time when you will give a definite answer,” says Cohen, who advises not waiting too long to give your answer. “Once you have determined that this is not something that you want to do, say no as soon as possible.”

Cohen also cautions doctors to avoid over-explaining or rationalizing your answer. “When you try to justify your decision, this can create a sense that you can be talked into agreeing and may lead to more pressure to accept.” Cohen reminds us that “no is a complete sentence,” and to keep in mind that it’s perfectly ok to say no just because you want to – you don’t need a reason.

To make it easier to say no, practice the technique of positive visualization. Imagine yourself saying ‘no’ in a calm and confident way. Picture the person you are answering responding favorably.If you find yourself falling into negative thinking, deliberately choose to imagine a more positive scenario. “The good news is that the more you practice positive thinking, the easier it becomes,” says Cohen.


Rebekah Bernard MD is a family physician in Fort Myers, FL and the co-author of Physician Wellness: The Rock Star Doctor’s Guide.