How to Say Yes When No isn’t an Option

[00:00:00] Rachel: The other day I met my teenage daughter at the station. I had been in town and I was going to cycle home with her. So we got on our bikes and I noticed that she wasn’t wearing a helmet. In fact, it was dangling off her handlebars. Yep, a lot of good there, isn’t it?

[00:00:13] Rachel: So I said to her, can you put any helmet, please? And she said, no. And I said, but we’ve talked about this. We’ve talked about the fact that you know, your brain is really important. You need to look after it. Drivers around here are not great. It’s not about you, it’s about other people. And she looked at me, she said, mom, I know all that, but somebody might see me. All my friends were just about to get off the train. And so we cycle home with her helmet dangling off her handlebars.

[00:00:39] Rachel: Now that seems ridiculous, doesn’t it? But thinking back to when I was a teenager, I could not go against what my friends thought. That just felt too difficult. And looking at my daughter cycling along with this helmet dangling from her handlebars, I realized that when we talk about boundaries, when we talk about minimizing your workload, we often talk about saying no. But sometimes saying no is just too difficult. It feels like it goes against everything inside us. And particularly in healthcare where we are defined by helping people saying no, just feels like a bridge too far, even when we know we should do it.

[00:01:19] Rachel: And of course there are other times that we just can’t say no either. So say if it’s genuinely part of our job and we feel we can’t go against our boss’s wishes. Or there’ll be really serious consequences, and in all good faith, we can’t say no to that. Now, I am passionate about the need to say, no, by the way, I’ve struggled with this all my life, but it got me thinking, what if there was a different way of saying no that actually felt more like a yes, which felt far more aligned to our values of helping rather than hindering?

[00:01:51] Rachel: This is a You Are Not a Frog quick dip, a tiny taster of the kinds of things we talk about on our full podcast episodes. I’ve chosen today’s topic to give you a helpful boost in the time it takes to have a cup of tea so you can return to whatever else you’re up to feeling energized and inspired. For more tools, tips, and insights to help you thrive at work, don’t forget to subscribe to You Are Not a Frog wherever you get your podcasts.

[00:02:17] Rachel: What I think we often get wrong about saying no is that if it just feels too hard, I just have to say an automatic wholehearted yes even if I don’t want to, it feels like my only option. And if you wanna hear more about the reasons why we really fear saying no, then we’ve got loads of loads of other podcasts about that. We’ll put the links in the show notes.

[00:02:38] Rachel: But I want to explore today the perils of this wholehearted yes. And suggest that there is another option. And the other option isn’t saying no. Because if we say this automatic wholehearted yes outta fear, out of guilt or shame or just pure habit, then actually we know that at the end of the day, it erodes her wellbeing. We end up really overcommitted. We end up resentful. If we keep saying these wholehearted yeses to things, eventually we’ll be saying no anyway, because we’ll burn out or we’ll have to leave.

[00:03:07] Rachel: And often we say this wholehearted yes, because we don’t want to treat people badly, but we end up treating people badly anyway. be cause our no leaks out in passive aggressive behavior or in other ways.

[00:03:19] Rachel: A few weeks ago I was at a hotel with some friends and in the morning we were having breakfast. And there was a group of four of us, but there weren’t any tables for four around. There were lots of tables for two people. And so we sat down at table for two and there was a lady who had just come down, put her room card on the table it. Looked like she was alone and she’d gone off to go and get her buffet breakfast.

[00:03:42] Rachel: When she came back, we asked her very politely, we said would you mind awfully if we had your table and put that together as to do a four? And there’s a couple of single tables on their own over there, would you mind? And she looks at us and she rolled her eyes and said, fine and stormed off.

[00:03:58] Rachel: And you know, we didn’t have a chance, so that’s okay, you can, you can have that table if it’s such a big deal. And then she sat at one of the other tables and she glared us. And in fact, she was with another friend. And when her friend came along, she ended up moaning really loudly and just looking at us if we’d done something absolutely dreadful.

[00:04:16] Rachel: Now she could have said no, I’m expecting someone, I’d like this table. That would’ve been fine. She didn’t say no. Instead she said yes. And then proceeded to treat us pretty badly or that’s what it felt like. And I realized that saying yes can mean that you end up treating people even worse than if you just said no. Because we’ve sort of been taught and we’ve imbibed this thing that if I can’t say no, I just have to say fully yes without question. But it’s just not realistic and it’s not sustainable.

[00:04:46] Rachel: So what if instead of a wholehearted Yes, we learned to say a differentiated yes? So you don’t have to choose between self-sacrifice and complete disengagement from your team. There’s a middle ground where you stay flexible, you stay compassionate, and you are really conscious of what you need and what other people need. And what’s more, you’ll be modeling helpful boundaries to everybody else.

[00:05:11] Rachel: Now, what is a differentiated yes? Well, I’ve come up with this term ’cause I think it’s a bit like making a differential diagnosis. So what you are looking for is the reasons behind you wanting to say yes and your decision to help. So instead of jumping to this automatic yes, you actually pause and you reflect and you think, what’s really driving my yes? Is it coming from fear? Is it rooted in guilt or shame, people pleasing or perfectionism, or is it rooted in, in more positive things like generosity, connection, and purpose? Is this aligned with my own values?

[00:05:43] Rachel: So just as you wouldn’t prescribe treatment for something without having a stab at what the diagnosis is, and to get that, you also need to consider all the differentials, this differentiated yes will really help you look at the motivation behind your agreement, and so that you can just respond wisely and sustainably. It helps everybody because it protects your time, it protects your energy. It really honors your limits, and it helps you stay aligned with your, your values and what really, really matters to you. So it helps you to say yes at the right time, to the right thing in the right way for the right reasons, but more importantly, it actually helps you put boundaries around your yes.

[00:06:20] Rachel: So I wanna think about what some shadow yeses are, what some positive yeses are, and how we can turn some of those shadow reasons into positive reasons and come up with this boundaried yes. So here are some of the different types of shadow yeses, when your Yes. Isn’t really about the request, it is for a different reason, which generally is pretty unhelpful. So you’re not saying yes because of the task, you’re saying yes because of some unhelpful beliefs or feelings.

[00:06:48] Rachel: Firstly, you’ve got your approval yes. Because everyone wants to be approved of and thought well of, don’t they? The motivation is wanting to be liked. You’ve got the avoidance yes where you’re just like dodging the discomfort of maybe upsetting somebody with your no. You’ve got the guilty yes, and that is where saying no would make you feel really selfish. And so often it’s just been ingrained in us that being in healthcare means helping people, and it’s so selfish if we fail to help people and put our own needs first.

[00:07:20] Rachel: The next thing we’ve got is the hero yes. So yeah, I’ll do it. I’m here to rescue everybody. We talk about being a rescuer a lot. We know that being a rescuer doesn’t really work in the long term, but it feels so validating. So here we are just trying to prove our value, and we might actually believe that it’s only us that can save the world.

[00:07:38] Rachel: Next, we’ve got the obligations yes. That’s where we feel everybody’s got this expectation of us. We might have that of ourselves. There might be a specific expectation of the role, and this is when we have these identities such as total doctor identity, we might think to ourselves, well, this is what I’m obliged to do or expected to do, and often these are based on really outdated expectations.

[00:08:02] Rachel: There’s the fearful yes, avoiding judgment from other people or perhaps even some negative consequences that probably won’t happen, but our amygdalas are saying, well, look what might happen if you don’t do that. And there’s the the love me yes. So that’s just seeking validation. Am I okay? Do you think I’m okay?

[00:08:21] Rachel: So all of these mean we’re saying yes, probably for the wrong reason, not because we really wanna do it, but ’cause we’re trying to avoid fear, shame, or guilt in some way. So I wonder if you find yourself saying yes because of any of those reasons? Now, there’s no value judgment here. I’m not saying you absolutely should say yes, or you absolutely should say no. What I’m looking at is what’s motivating you? I need to know that you’re saying yes because you really wanna do it, because it aligns with your values. Being motivated by fear, guilt, and shame will just lead to resentment in the long run when you are overloaded with all these tasks you didn’t really want to do.

[00:09:03] Rachel: So what are some positive reasons for saying yes? Well, of course there are loads aren’t there? Some of the healthier reasons are generosity. You really want to help. That’s, that’s a good thing, isn’t it? And we know in terms of the ways to wellbeing that giving is one of the things that really makes us feel better and feeds our soul.

[00:09:24] Rachel: Connection is another way to wellbeing. So often we wanna say yes because we really value the relationship, and it helps us connect with that person. That is a positive reason. You might be saying yes because it really aligns with your, your values. So there’s a shared purpose there. I’ll say yes to doing that ’cause I really care about that cause. And we know that doing meaningful activities and things that work towards this purpose that we have in life, or a higher purpose or something that’s beyond ourselves is very, very fulfilling. So that’s a really positive reason to say yes.

[00:09:56] Rachel: Another way to wellbeing is learning and growing. So growth. If I do this, then actually that will help me learn and grow. That’s a great reason to say yes. As well as doing something. ’cause it energizes you. It brings you joy.

[00:10:11] Rachel: I remember a couple of weeks ago, it was a Sunday evening. I was really, really tired and my son asked me, Mom, do you wanna come to the gym? I thought, oh, I really ought to go to the gym. I ought to support him as a good mom. Then I thought, well, actually, what’s gonna bring me joy? And I said, oh, you know what I, I don’t feel like the gym, but should we go and play tennis? I know that will bring me joy. And he said, yeah, yeah, I’d love to. So off we went. So that was a really positive yes that I could say.

[00:10:33] Rachel: Another really positive reason is reciprocity. We don’t talk a lot about this in healthcare, but it’s often at the back of our minds. So reciprocity is simply, well, if I help you, then actually you may will help me in the future as well. It’s not a manipulative thing, it’s just like, well, this is how I’d like to be treated, so I’m treating you like that, and hopefully that will happen back in the future. And it’s about mutual support.

[00:10:58] Rachel: And finally the most healthy yeses is the real integrity yes. It really aligns with who I am. That’s great. That one does come with a health warning because the integrity. Yes. Is then. Very closely linked to the I should yes. If I’m gonna be integrity, I really should do that. That’s not what I’m saying at all. But integrity is one of the biggest reasons for really wanting to do something.

[00:11:22] Rachel: And the best yeses come from real clarity about your purpose, about your values, not from compulsion, from fear, guilt thinking I should or I ought to. They come from I will, I want to.

[00:11:37] Rachel: Now in reality, all of us are gonna have a mixture of some shadow yeses and some positive yeses, and sometimes we can move some of the shadow yeses and reframe them into some positive yeses, such as that need to be liked we can reframe as I really value our relationship, here’s what’s sustainable for me. The I’m feeling really guilty about this can be reframed into I really care, and I want to be able to give and help from a, a place where I’m resourced, that’s sustainable.

[00:12:05] Rachel: And if you’re thinking, well, I just always say yes, so I need to carry on, we can reframe that tool that’s changing and I need to say yes differently right now. So just have a think, you know? When was the last time you said yes that didn’t sit right? Which one of those shadow yeses was it? And when you have said healthy Yes. How did it feel to you and how, how did it feel different from that shadow yes?

[00:12:28] Rachel: So let’s just talk about how we do this. How do we give a differentiated yes, where we’ve worked out what our motivation is and we’ve reframed some of the shadow yeses into a positive yes, but with boundaries, so we’re not saying yes to everything and it doesn’t go on forever, and it doesn’t add to our plates and make us feel even more overwhelmed?

[00:12:51] Rachel: Because we’ve all done it, haven’t we? Whether it’s saying yes to reviewing someone’s article, but then we’ve got to look at four or five different versions or rewrite it or look something up and it takes us four times as long. Or we’ve said yes to doing a, a quick presentation, but actually the person wants a presentation four weeks in advance. There’s suddenly all these other expectations. Or someone’s asked us to give a quick second opinion on something or just see this extra patient and something that we thought was gonna take us five minutes, takes us an hour, and there’s ongoing follow up, there might be complaints, you’re embroiled this politics and suddenly it’s just spun out of control.

[00:13:30] Rachel: So here’s some steps you could use to give an undifferentiated yes.

[00:13:33] Rachel: Firstly, work out what the cost is. You can use the yes cost calculator. So firstly, what will this cost me in energy? What will it cost me in time? And I heard a podcast recently that said, however long you think it’s gonna take, times that by four, I normally say double it, but times it by four. And when I think about it, actually that is probably the right figure. So what’s it gonna cost me? An energy and time, and what will I have to deprioritize in order to do it?

[00:14:01] Rachel: I heard about someone that kept a photo of her kids on her desk, and every time she agreed to speak at another conference, she picked up the picture of her kids and said kids, I’m telling you, I’m speaking at that conference so I won’t be with you that day. Now that’s a little bit guilt inducing, but actually if you are directly thinking about what you are gonna deprioritize, that might just stop you in your tracks, and actually think about, well, what boundaries do I need to put around this yes?

[00:14:24] Rachel: The next question in the yes cost calculator is what will future me say? Will they thank me or will they be really cross? When they get to that thing in the diary, if it’s a sort of time bound thing, will they be pleased or said yes, or will they be really, really resentful, and just think to themselves, why did I not say no? And I’ve done a podcast about the future me safeguarding the future me. So I’ll put the link in the show notes.

[00:14:48] Rachel: So next you need to identify the motivation. So ask yourself, is this a shadow yes? And if it is a shadow yes, here are some reframes that you could use.

[00:14:57] Rachel: If it’s the approval thing, the reframe would be, let me just check my capacity before I commit to this. If you’re saying yes because of guilt, you could say, the person that, I really wanna help with this, but I wanna do it in a way that’s sustainable. If you’re saying the hero yes, then reframe it to, well, I’m really happy to contribute, but how can we share the load over everybody so I’m not the hero here and I’m not rescuing everybody?

[00:15:18] Rachel: If you’re saying yes out of obligation, reframe this and think, actually I have another professional obligation and that is to honor my limits. And that right now trumps any sort of outdated obligations I’m feeling. If I’m saying a fearful yes, I might think, well, how can we explore a way that that’s gonna work for both of us? Is there a third way where I might not experience those consequences, but I’m not saying that wholehearted yes either? And finally that love me yes, seeking validation, a reframe is actually, I know what I’m worth. I know my worth. Do I need to do this just to be validated? Here’s how I can help wisely. So identify those shadow yeses.

[00:15:56] Rachel: Now, if you have a healthy yes, then great, but before you turn it into a wholehearted, yes. Think about how you could make it a differentiated yes. And here’s some reframes that you can use to say, a differentiated, boundaried, and sustainable yes.

[00:16:13] Rachel: The firstly, I can do it, but not all of it reframe. I love this one because it says, yes, I can help with parts of it, but not the whole thing. And that will help you with the overwhelm by just limiting what you do so you’re not doing everything.

[00:16:26] Rachel: Next reframe, the if I do this, then I won’t do that reframe. So here you might say something like, well, I can do this, but something else is gonna need to wait or should we agree what that is? So you are losing an equal amount of time and energy from what you’re not gonna do in order to say the yes.

[00:16:42] Rachel: Next, we’ve got the yes, but not now reframe. And this goes along the lines of something like, yes, I’d be happy to do this, but I can’t do it until x. Does that work for you? Really clear sets expectations.

[00:16:54] Rachel: The next one is the let’s share the load. Reframe. So yes, I can do it, but I can only do it if you help me and we share the load. So that might go something like, yes, as long as we can spit the work or set some limits together.

[00:17:07] Rachel: Next we’ve got the conditional contribution reframe, so it’s yes on these conditions. So yes, if it’s only gonna take this amount of time, or we can agree on a time limit. And have a clear scope so that I’m not going to overextend. So that can be really, really helpful. And in fact, I think it’s really important for any yes that you say to say, okay, what’s the scope of this? What am I expected to do as Brene Brown says, clear is kind.

[00:17:32] Rachel: Next, we’ve got the time box yes reframe. So it could be right, I’ve got 20 minutes, whatever I can do in this 20 minutes, I’ll do and then stop. Or you could say, yep, I’ve got 50 minutes right now. Let’s use that time to move things forward on this. And then I can’t do anything more.

[00:17:48] Rachel: And the final two, the clarify and confirm reframe. This is something like, well, I’d be happy to say yes, but firstly, can I just clarify exactly what this commitment looks like or what success looks like, just so that I don’t overcommit? So you know from the outset exactly what’s expected of you.

[00:18:05] Rachel: And finally. You’ve got the clinical safety first reframe. So I’d love to help. I need to say clinically safe because I’m at capacity right now. So what can we shift to make this thing manageable? And that just acknowledges our own limits. And that’s quite hard to argue with, isn’t it?

[00:18:21] Rachel: So in the workbook for this quick dip episode, we will provide a crib sheet of all these different types of reframe that you can keep, I don’t know, on your phone or next to your desk. So next time you’re asked to say yes to something and you feel you can’t say no, you can just use one of these helpful reframes. And of course, the worksheet is available to all the members of our FrogXxtra membership.

[00:18:43] Rachel: Because these reframes just help you remain helpful and collaborative without ruining the relationship, but without compromising your boundaries, your clarity, or your wellbeing.

[00:18:53] Rachel: And of course you can use all of these reframes together to, to have a real sort of negotiated, yes. So for example, if somebody asks you to see an extra patient, you could say something like, I absolutely understand this patient needs to be seen, and of course I want to help, but I’m currently at capacity, i’m really worried about doing a rush job or really compromising safety. So I could see them now if somebody else does my discharge summaries, or I could see them now if someone else is happy to do those two medical reports that are waiting for me and need doing by tonight, or perhaps the duty doctor could see that patient and I’ll do a couple of the phone calls quickly for them. What do you think is the safest thing to do, or what would you like to do? Or perhaps I could delay this other thing till tomorrow, but tomorrow I’m really overbooked, so you’re gonna have to shift a couple of patients out to somebody else. I don’t know. Use your negotiation tactics. There are lots of different ways of doing it.

[00:19:47] Rachel: So next time you’re in a position where you really can’t say no, it might be a teenager helmet type situation where you know saying no would be the best thing, but you just can’t bring yourself to, for all sorts of reasons. Or actually saying yes is the right thing to do here. But you’re at capacity and you’re overwhelmed. Try saying a differentiated yes. The way to do that is uncover your underlying motivation first, get the differentials, work out is it a shadow? Yes. Or is it a positive yes? Think about what the time and energy cost is going to be. And then think about how you can say a differentiated yes, instead of a wholehearted. Yes.

[00:20:27] Rachel: So this week, pick one situation where you would normally just say yes automatically. And pause. Try that differentiated yes system and then reflect. What happened. Did the world stop? Did really awful things happen? Probably not. So if you can’t say no, make the differentiated yes your go-to, not the wholehearted yes. And maybe, just maybe, this is the answer to the say no problem. We never think of it as saying no. We just think of it as saying a differentiated yes.

[00:21:00] Rachel: I’d love to know your thoughts on that. Please drop me an email at hello@youarenotafrog.com, let me know your thoughts. Let me know some of your reframes that you’re gonna use. And above all, let me know how it goes. We need to set boundaries. It’s the only way we are gonna step away from burnout and, and work sustainably and be there in the long run for our patients, for our families, and for ourselves.