I suspect that I'm not the only person in medicine who is a people pleaser. Since elementary school, I've always been very academically successful, and the resultant praise from teachers and relatives has given me a lot of pleasure and personal satisfaction. Going to medical school and becoming a doctor took this to the next level, as suddenly patients and even strangers were regularly praising me for the work I did.
The big problem with getting so much validation externally is that you start to be dependent upon it. You need people to tell you how important you are and how no one else can do what you're doing. And so you constantly seek ways to keep that validation coming. You say yes to giving one more presentation or fitting another patient into your clinic or teaching one more tutorial. Even when you don't really want to be doing any of those things.
Over the past few months, I've been feeling depleted, as I keep telling my partner. I've been feeling overwhelmed by work; I've been having difficulty sleeping; and I've been hit with a bone-weary exhaustion that reminds me of my residency days. I had hoped that a recent trip to a cabin would fix things, but four days away just wasn't enough. I'm tired.
And despite this, people keep asking for more. Start a research project. Do more training. Teach another academic half day. More, more, more, when all I want to do is stay in bed with my cats. It has reached the point where I feel anxious not only when my pager goes off, but also when my inbox pings, signalling the arrival of another email asking for my time and energy.
So this year, I'm going to learn to say no. Thank you for the opportunity, but that isn't my priority. My priority needs to be finding balance, a level of work and engagement that I can happily sustain for the next 20 years, not saying yes to every single request that comes my way. I need downtime and sleep and yoga classes and running and home-cooked food and time with the people I love, not another item on my to-do list.
It sounds straightforward, but it goes against the very essence of medical culture. Physicians pride themselves on being able to work a 28-hour shift and then go climb a mountain on their post-call day. Medicine is the North American worship of busyness and achievement taken to the extreme. Saying no means being inadequate and not measuring up to the standard.
And Medicine doesn't always listen to no. A few weeks ago, I was emailed a request to help someone out with a presentation. My stomach sunk when I read the email, because it was something that I really didn't want to do, even if I had had an abundance of time in which to do it. So I sat on the email for weeks, debating the merits of saying yes versus no, until I finally got up the guts to sent a polite email declining the request.
The response? Within seconds, a return email that basically said "Can you do part of the work for me?".
I'm still completely flabbergasted by the response. Why is my attempt to protect my happiness and my time not respected? Why am I expected to say yes to every request that comes into my inbox?
Learning to say no isn't going to be easy. It's going to mean letting go of the need for other people to tell me how wonderful I am and what a good job I'm doing. It's going to mean letting go of the belief that if I were just better, just like every other physician, that I would be able to say yes to everything. It's going to mean ignoring the blogs of the overachievers, who have a medical practice and children and exercise daily and cook healthy food, and setting my own standards for achievement. Because ultimately no one cares about my happiness as much as I do. And no one else in Medicine is looking out for my well-being as much as I am.