The art of saying no

Healthcare is an inherently busy field that is always moving and changing. Between seeing patients, managing staff and keeping up with charts, CMEs and countless other tasks, the life of a physician can be overwhelming.

Oftentimes it feels easier to take on more tasks because delegating takes just as much time. However, this way of thinking makes it difficult to ensure the most important things are getting done. Learning to say no is one of the most important things you can do to achieve your long-term goals.

Take a minute to write down what’s most important to you, and then ask yourself these questions:

• How are you spending your time?
• Where do you expend the most energy?

If the answers to either of these questions are not focused on your key goals, then it is time to start saying no.

Why it’s difficult to say no

Obviously, this is easier said than done. Physicians are fixers. You seek out and address problems, so it is natural to want to say yes to a last-minute request or when someone else has a problem you could potentially help with-even if you don’t have the time. Other times it appears easier to address something yourself even if there may be someone else who could better handle the request.

The book Essentialism by Greg McKeown identifies these types of requests as nonessentials. These are the little tasks that suck your time away without yielding any long-term benefit. So, how do you say no and eliminate the nonessentials?

Determining the essentials

The first step is to look at each thing you do and determine what are the essentials and what are not. Write down everything you did during the day. At the end of the day, go through the list and identify the tasks by these categories:

• Tasks essential to my primary job responsibilities,
• Tasks I could have delegated to someone else,
• Tasks that needed very little or none of my feedback, and
• Tasks I didn’t need to be involved with.

Once you look at your tasks, quantify how much time you are spending on each category. Is it what you expected? Are you spending a lot of time on nonessentials?

If you checked off all of your tasks as falling under your primary job responsibilities, look one more time.

For example, transcribing notes may be a necessary task but could it be passed on to a scribe? Are there cases that could be delegated to physician assistants, nurse practitioners, or other members of the team, leaving you more time to focus on other cases? Could personnel issues-whether that’s hiring new employees or creating work schedules-be solved by hiring human resources personnel or delegating more responsibility to an administrative employee?

Steve Jobs once said, “Focusing is about saying no.” You only have so many hours in a day. The more tasks you take on, the less attention and focus you can give to each. If you can reflect on your day and say you spent it wisely, you were probably doing the right things.

Saying no is not a bad thing. Say no to the nonessentials can give others opportunities to grow while allowing you to focus on what is most important. In the long run, this will be better for your patients, your co-workers and yourself.