How to say "no."

0:00 Welcome to the Clinician Researcher podcast, where academic clinicians learn the skills to build their own research program, whether or not they have a mentor. As clinicians, we spend a decade or more as trainees learning to take care of patients. When we finally start our careers, we want to build research programs, but then we find that our years of clinical training did not adequately prepare us to lead our research program. Through no fault of our own, we struggle to find mentors, and when we can't, we quit. However, clinicians hold the keys to the greatest research breakthroughs.

0:40 For this reason, the Clinician Researcher podcast exists to give academic clinicians the tools to build their own research program, whether or not they have a mentor. Now introducing your host, Toyosi Onwuemene. Welcome to the Clinician Researcher podcast. I'm your host, Toyosi Onwuemene, and it is such a pleasure to be talking with you today. Thank you for tuning in. Well, yesterday I talked about why we should say no, and the question that arises is that, well, how do you say no?

1:21 How do you say no? Because it's super hard to say no, and if it was easy, everybody would be doing it. We learned yesterday about the importance of saying no, because it means that you are able to create time and space to advance as a clinician researcher, as you really want to. And so today we are going to continue that conversation, and we're going to talk about how to say no. And when it comes to saying no, I don't want you to do it like me, where you start to say no, and then you end up somehow finding the words yes coming out of your mouth, or you're feeling so much pressure in the moment that instead of saying no, you know you should say no, you feel like, okay, let me just go ahead and say yes.

2:12 So I want to share with you, I want to share with you a couple of things that are important to think about in saying no. So how to say no. So the first thing I'm going to start with is talking about how do you manage, let's say the no committee. Actually, before we do that, let's go back to where we started with yesterday's episode. So we talked about the importance of saying no, and that the reason you say no is that you recognize that no and yes go together. So you're never ever really saying no in isolation. Every day you say no, you're also saying yes, and vice versa.

2:54 Every day you say yes, you're also saying no. And so the question is, do you really understand the two sides of the coin? When you're saying yes, oh my goodness, yes, I'll do this, then what are you saying no to so that you can create space for the thing you said yes to? And similarly, when you say no to something, what you're really saying is that, well, I have a bigger yes in the background. You can't see it, but there's something bigger. There's a reason why the no is coming forth because I'm really saying yes to something else. So I just want to start there from the perspective of you got to know that every time you say no, you're saying yes. OK, so that does lead me to number one. And what is number one? Well, number one is that if you say no, it's because you recognize that there's a bigger yes that you're supposed to say, right?

3:44 You recognize that there is a bigger yes somewhere. OK, so if there is a bigger yes, the question is, what is that yes? And so the number one way how to say no is to figure out your yes. Figure out what is the thing that is so important that occupies a high priority for you such that there is a list of things that come and no matter what it is, as long as it falls below that high priority, the answer is an automatic no. And that's really important. But it also is important to clarify what that yes is. For example, if you're a clinician researcher or an aspiring clinician researcher, and by the way, I'm not wedded to any names.

4:26 The podcast is Clinician Period Researcher. And I know sometimes I start seeing clinician researcher and people are like, but I'm a clinician scientist. And then someone else is like, I'm a physician scientist. It's OK. It's OK. Don't panic. I'm fine. And whatever you want to call yourself, I support you. OK, so you're an aspiring clinician scientist. That was a digression. You're an aspiring clinician scientist. And you recognize that in order for you to get your science out there, to establish your research program, and to become known for what you do, you do need to create time and space for your science.

5:09 You need to create time and space for the thinking, for the working, for the writing that it takes to be able to move your work forward. And therefore, if you're a clinician scientist, one of your highest priorities is moving your work forward. Therefore, everything that gets in the way of you moving your work forward is a no. It should be a no. You hope it's a no. But here's the thing, though. The thing that's needed to allow you to lead in your research is not always obvious. And sometimes it feels like, yeah, there's space. I can do that later.

5:51 That's why you've got to recognize what it is you're trying to protect, what's your bigger yes. And then you've got to figure out how to protect it so that, yes, you're not just going to sit in your lab or sit in your research program and do that all the time. You do have other things you have to do, including eating and sleeping, meeting with other people, seeing patients. You've got a lot of stuff in there. And so the question is, what is the optimal time for you to do the work? That's the big yes. OK, I'm a clinician scientist. My research, in order to move it forward, I need about four hours of writing time daily. OK, that's a lot of time. I don't know how many people who have that, but maybe you do. But maybe it's not four hours all at once.

6:33 In the early hours of the morning, you're a great thinker and you're a great writer at the same time. And so you protect that time of the morning where you do your best thinking and your best writing. OK, so maybe that protected time is about an hour, an hour and a half. OK, you have it. It's in there every morning. OK, the remaining two and a, what's that, about an hour and a half, two hours may not be dedicated focus writing time, but maybe that's the time you meet with your research group. And so there it is. There is a time in the week where you meet with your research group. OK, you have mentees in your program. And if you don't, you should find them.

7:13 And these mentees are going to meet with you because they're helping you move work forward. Or maybe they're not mentees. Maybe they're research staff. They're going to move work forward. And you want to create time to meet with them so that you can look and see the hours in the day in which you meet with these people. Now, when it's a hardcore meeting, that's not difficult to say. It's not difficult to say no when another meeting comes up. It's like, oh, I have this meeting. Other people are meeting with me. But the meetings we have with ourselves, that's really, it's easier for us to justify giving those times away. And so it's important for us to recognize how important our research time, our writing, our thinking time is to our forward advancement so that we can guard that time generously.

7:57 And so every time somebody says, hey, there's a patient who needs to be seen in two days during your writing time, the answer is actually no. And yes, the patient needs to be seen. And yes, it is an emergency. And who else can help in that time? Because I actually do have a meeting. And it's not with someone else. It's with myself. And if I cancel that meeting, I'm canceling a commitment to myself. And I don't get that time back. Right? It's like, well, maybe the patient needs to be seen. When else can the patient need to be seen? It's not within that one and a half hours of optimal writing time. OK. So I'm giving that as an example. But what I'm really telling you, number one, is how to say no is to really understand how big the yes is.

8:38 So I gave an example of writing time. Easy to give away, but so critical to moving you forward, you really should have a very high threshold for things that you say yes to that move that time out of the way. And as a clinician scientist, you literally have to fight for that time because people are always fighting to take it away from you. They're like, well, I don't see anything else on your schedule. I see that you're meeting with nobody. Therefore, you must be free. Just because you look free, just because they think you're free doesn't mean you have to agree that you're free. OK. So the how is really understand what the big yes is. OK. The other piece of that is if you say, OK, I'll move my writing time from early in the morning to like 3 p.m.

9:19 I'll just make this out. I'll go do the patient care that they need me to do. And I can come back to my writing at 3 p.m. Number one, you're not you're not you're not your best writer at 3 p.m. So that's that's a problem. But number two, if you're starting your writing at 3 p.m., what are you going to do your clinic notes for those patients that you saw earlier? Oh, so now we're pushing the day to where you're about. Maybe you're going to be here 5, 6 p.m. and your kid has a soccer game that starts at 430 that you had already made a commitment to be at. That's a big yes. The soccer game that you made a commitment to be at the other stuff that the emergency patient care activity that took away your writing time in the morning that pushed your writing time to the afternoon that also gave you extra work to do at the end of the day.

10:04 Those are notes because of the big yes of got to move my research forward and the big yes of I'm committed to this time spent with family. And so how to say no is to recognize your yeses and to clarify what those are. That's number one. Number two, people talk about the no committee. So I'm going to talk about the no committee. And the no committee I feel is a mixed one for me because I love the idea of a no committee. But here's the thing, you're the one making decisions for your life and your career. And it's great when you have someone or a group of people that you can sit with and say I need to say no, how do I do it? That's great. But remember that in the process of growing as a clinician scientist, we're adulting as well.

10:48 We're going from where we need a big bad brother to protect us all the time to where we are able to make those decisions on our own. And so I don't have anything against the no committee. But when I think about a no committee, what I think about is making sure you have space on a regular basis, not just for saying no, to be able to reflect back to you what's critical, what's important, what are the things you should invest in, where are the places you should go, those kinds of things. Like what are the opportunities you should be thinking about. So have a platform regularly to be able to voice those things so you can practice for yourself what yes looks like in your life.

11:28 So I'm not necessarily, I think I'm not big on the no committee because I think you should be able to get to a place where you can say no by yourself. But what I do want to say is that yes to the no committee, but I want you to think about it a little bit more broadly. Your committee you meet with regularly to help you say no should really be a committee that you meet with regularly to help you think about your career. And for me that looks like peer mentoring. For you that may look like something else. It looks like peer mentoring, it looks like meeting with a mentor, it looks like meeting with people who help you advance, whatever that looks like. But so let's call it a no committee. What I'm really asking you to do is think broadly.

12:10 Who are the people who help you think about advancing your career? So you begin to have opportunities and spaces where you can practice saying this is what's a priority for me and for that reason this is a definite no. Okay, so the first thing I talked about was understanding your big yes, what you really are saying yes to. And number two is the no committee. Okay, number three is space. Okay, so there is a quote. I think it's by Viktor Frankl and he talks about how between stimulus and response there is a space. This idea I came across in the seven habits of highly effective people.

12:52 And he says between stimulus and response there is a space. Now some of us are really good so that even though that stimulus and response the distance is just a couple of seconds, some of us are great. We can do that. So between stimulus and response between the hey can you do this for me and the 30 seconds later definitely no. We're good at that. For the rest of us, especially those of us who are struggling people pleasers, many physicians that I know, many of them women too, many people who are underrepresented in the academy, your first instinct is to say yes because our people pleasing instincts are to accept short term gain.

13:36 If I say yes, you're going to be happy with me and I'm going to feel better. And so for us what we really need is a lot of space between the stimulus and the response. I need space between the stimulus and the response for that reason. One of the things that you get to learn to do or I'm encouraging you to learn to do is to really expand that space for yourself. Now in expanding that space it may be that you say hey let me sleep on it and get back to you tomorrow. Let me think about it for a day or two or you get to expand the space in such a way that you are so clear on what yes means that you don't even need too much time to think about it.

14:20 It's like hey can you be available for this last minute meeting at 8 a.m. at your writing time? You're like no, no, definitely no. You already know that the answer is no. Now it could be that it's your chair who says I'm not sure you should keep working here. Can we talk about it? Okay. Then all of a sudden it's like okay, need to open up that space because this might be a really priority meeting. So there are things that are clear that might immediately allow you to in a sense expand that space because you already know what the answer is. But for the most part you do need enough time to really evaluate the opportunity. One of the things that happens to us in academic medicine is that there are so many things that look great when they are talked about especially on the surface.

15:05 When you go and you really sit down you think about it you're like no I don't think so. No, no, no, no, no thank you. But it really does take time for you to peel away the layers of who's asking you to do it, what's their position, how much do you owe them, what are all the awesome things you've done, they've done for you, where you feel like now you're obligated. It takes time to peel back all those layers to really understand how do I feel about this opportunity that I'm being offered and is this consistent with the direction that I want to go. So now that brings us to number four. Okay so number four is your direction.

15:46 Okay you've got to understand where you're going and why it matters that that's where you want to go. So I spoke at the beginning about the bigger yes, you got to know what the bigger yes is and that's kind of situational like you know that at 8 a.m. there is a big yes to your writing therefore you say no to anything that wants to take over. You know that at 6 30 p.m. there's a big yes to the soccer game and so you know that anything that wants to take that space is a no unless it's really high priority. So that's a little bit situational. What I'm talking about is direction. Where do you want to go? Now if you want to be a clinician scientist where do you want to take your research? What do you see for yourself? What do you see for your research program?

16:26 And having a clear direction helps you understand where you want to go and because you know where you want to go then you know what it costs to get there right because if you're going to fly to Cincinnati or wherever it is you're flying to you ought to get on a plane and it costs money to be on the plane but you know you're going to Cincinnati and you know how much flights to Cincinnati cost and therefore you're going to pay the price. It's the same way in our careers. We have a clear sense of direction of where we're going where we want to be then we have an understanding of what the price is. Now many times the price becomes very clear over time. It's like whoa is this how much it costs? I didn't know that but there's kind of like an accepted standard for what that price looks like.

17:11 Therefore when you understand the direction you want for your career you ask this what is the price I pay to get to this place? What will it cost me? And then you work to pay the price and how that helps you say no is to ask yourself what are the things that people ask me to do that doesn't align with the price that I'm paying to get where I want to go? What are the things that people are asking me to do that costs me such that I can no longer pay the price for where I want to go? This is such an important thing and to be honest this is where the NO Committee could be helpful because sometimes things seem shiny and you know they're cloaked in anxiety and worry and you're not wanting to displease someone who's really important but what's really really important is for you to pause and say hmm does this cost me in the area that I said I wanted to pay a price to get to?

18:12 Like does it take away from my paying a price for that place so that I can get to the place that I want my career to go? So that's one of the things you need to think about, direction. Number five is being gracious and showing gratitude. So whenever people say hey can you do this always say thank you. It doesn't matter how awful the thing they're asking you to do maybe they're like you know what I've decided I'm going on vacation next week and I have a clinic full of patients and I see that you're free can you take my patients? No matter how ridiculous it seems always say thank you. And here are some reasons to say thank you. Now I don't believe in saying thank you when there's no good reason for thank you and so what I'm asking you to do in this situation is find a reason to say thank you.

18:58 They're like well there are many faculty members throughout this department faculty members in our department and you chose me. It must be because you think that I am able and equal to the task. It may be that you think I'm a really nice person. Whatever it is thank you and yes you may have a few choice words for them you may think no this is ridiculous it doesn't matter just say thank you. Because being gracious allows you to deliver bad news you know that you have clinical training and you know that if you are going to deliver bad news you start off being as kind as possible as nice as possible and even if the person is losing it because they're anxious or they're afraid and they're angry you don't lose it you speak to them calmly and that's what this is.

19:46 Somebody said hey you know what there's a medical director position opening up and yeah it'll take about probably six hours of your day three days a week. Now they won't tell you that they'll tell you it only takes an hour of your day. But I digress you say wow you thought about me for this amazing role thank you and whatever you say after that whatever you say after a gracious thank you is gold. Like it's hard to say thank you genuinely so please don't say thank you through clenched teeth because people can tell that you're not being sincere and I feel like well I don't feel sincere about the thank you then go take time to become sincere.

20:27 Say let me think about it so you take the space and then you say what are all the good things I can find to show gratitude. Maybe you're thinking in that moment I'm so thankful that I know exactly what direction I'm going in so that I don't fall for this. Maybe that's what you're thinking and you're like thank you thank you for revealing to me my priorities. I mean you're not going to say that but whatever helps you recognize that you're going to show gratitude that's what I want you to do show gratitude. Okay and the reason you show gratitude is because whatever comes after that gratitude lands better. Thank you so much for thinking about me for this amazing opportunity and I would wish I could take it.

21:08 It would be amazing and I don't think it aligns with my priorities right now. Perhaps it's something that I will be ready for in about two years. I don't think I'm ready for it now. So we always want to show gratitude because gratitude helps you do the gracious thing that comes after gratitude is to find a way to say it in a way that's nice and kind. Okay and maybe that's the last thing. The last thing is to be kind. There are two people you need to be kind to whenever you say no the first person is you. Saying no is hard. If we are way beyond our terrible twos if you ever went through terrible twos saying no is hard work and so the kindness you show first is to yourself to recognize that it is hard and so to take the time to prepare to do it.

21:59 Don't procrastinate don't defer it but take the time to do it to say no. Be kind to yourself and then also be kind to the person who's asked you to do it. Perhaps you know that they're being actually obnoxious they're actually being obnoxious you know it. Still be gracious and kind and say thank you and no I'm not able to to do this thing. Okay so I've given you a couple of reasons a couple of ways to say no and number one is to have a bigger yes. Number two is to have a no committee or a broad committee that you can talk to. Number three is to make sure that there is space between the stimulus the question that you're asked and the response that you're able to really think it through.

22:47 Number four is to have a clear sense of the direction you're going in so you understand how much another price another charge costs in terms of your big direction. Number five is to show gratitude and number six is to be kind first to you and then to the person who made that request of you. All right I'm interested in hearing your thoughts saying no is super hard and so if you have ideas on how to say no I would love to hear it. Do me a favor leave a message for us on the podcast. There is a voicemail feature if you go to the website clinicianresearcherpodcast.com leave a voicemail and I will play your message in a future episode.

23:33 Now it may take a while because I batch record these episodes and so you may be like three weeks from now and you're like I haven't heard my voicemail but be patient it will come but go ahead and share a voicemail share your ideas and I will use it and turn it into an episode. Okay that's the end of today's episode I want to thank you for sticking around this long. I look forward to the next time definitely share this with a friend or mentee or someone else who needs to hear it. All right I'll talk to you again the next time. Thanks for listening to this episode of the Clinician Researcher Podcast where academic clinicians learn the skills to build their own research program whether or not they have a mentor.

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