Letters to a young doctor… Learning to say No

‘What has been the hardest lesson you have had to learn?’

‘Saying No instead of Yes….’


It has been surprising to me that the hardest lesson I learned from Medicine is how to say “No’.  I suspected the lessons in school would be the hardest, maybe the ways to have delicate conversations, or to sit with the dying.  However, nothing comes close to learning to say “No’. 

What makes saying ‘No’ difficult is that ‘Yes’ arises so easily, so naturally.  It happens all the time. You have been programed to say ‘Yes’ by your journey, by society.  In fact, the very people you love so dearly have modelled the many ways in which you will spend the rest of your life saying ‘Yes’, when you might be better off saying ‘No’.

How I Learned to say Yes…

LaNere, my beloved grandmother, the one who always knew I was going to be a great doctor, could never say ‘No’.  She came by this naturally, a product of the depression, when it was clear she was an extra mouth to feed.  She heard ‘No’ most of her young life, and it was not until she met my grandfather, that she began to hear yes from others.  She never said ‘No’ to me growing up, and it stuck. 

Mother and father also modeled this behavior, helping all who asked, even when it meant taking time from the family.  They were loved by the community for the many ways they said ‘Yes’, and in those ways, they trained me to say yes also.  My time in Boy Scouts taught me to say ‘Yes’, to be courteous, kind, and friendly in the process of being helpful.  All of these adults helped me learn to say ‘Yes’, I learned that this is what kind people did.  By the time I was applying for medical school, I had undergone decades of programing to say yes to those around me.  I had learned how good it felt to say ‘Yes’, feelings of fulfillment from being helpful.  Little did I know it was hiding an unmet need.

It is common in medicine…

Gabor Maté has said that ‘medicine is the perfect drug for those that need to be helpful’, and there are no more perfect addicts for this drug, than young doctors.  Recall how it felt to write that application essay on why you wanted to enter medicine.  Remember the feeling you had in the interviews when you spoke with the students and residents, how much you longed to be like them, out there in the world, helping others, healing the sick.  This was the chance to really be needed, to really be helpful, and you chased it down.

It should be no surprise that learning to say ‘No’ is going to suck.  Believe me it will.  It will not be easily at first, you will be forced into it by the unfortunate circumstances of saying ‘Yes’ too often.  You will find yourself angry and irritable because you said ‘Yes’ too many times, it will leak out of you onto whomever is in front of you, much to your dismay and their regret.  Anger will be the first clue card that maybe, just maybe you should ask some deeper questions about what is happening.  You will not do this, you will push things down, drive on, just like you have been trained to do.  It is what we do in medicine, and you will be no different, you give to others because that is what Doctors do.

You will wrestle with you anger, chasing it to blank walls of your mind trying to figure out why it is there.  You will burn in frustration as your anger spills out onto your spouse, and the patients asking for your help.  You will try to hide it from them, but they will feel the sting of your sharp tongue.  Your pronouncements about their choices, their decisions, will make it clear exactly how you feel.  Afterwards you will reassure yourself that you chose those words to encourage them to make ‘better choices’.  No one will be encouraged, they will be scared, withdrawn, afraid.  They will recognize it on some level internally, and it will get in the way, it will be a brick wall.

In the end, you will turn your attention inward, searching for the source of your discomfort.  It is there that you will begin to see the truth of where it all comes from, to see the pain it has caused you, and others, throughout your life.  You will see how your relentless ‘Yes’ hurt you and those you love.  You will see how your ‘Yes’ has been a vain effort to fulfill needs that can only be filled from within, and that will be the hardest thing you learn from medicine. 

It is ok. I see all that you become and can tell you that the lessons learned were valuable, integral to prepare you to turn inward and look at your heart.  It is no different than preparing a field for hay.  Steps must be taken to make it ready, and even then, the harvest will not come for several years.  Do not try to avoid this lesson, dive in, get dirty, make your field ready, allow your heart to be broken, give more than you have until you are emptied again and again, and notice how you begin to question yourself, becoming curious about what it is that drives you along this path, and if you can, take a moment here and there to really enjoy the journey that you are on.

Be safe, and I will see you when you get here…

Sincerely Gil

This is a series of letters to a young doctor from so long ago, please follow along with me as we explore together this life in medicine and touch the history that has formed in the process.  If any of resonates for you, and you happen to be curious, and wish to know more, do not hesitate to drop me a line. If you would like to know more about my work, or to work with me, feel free to contact me.  I post regularly to Instagram (@gilgrimes), Twitter (gilgrimes) , Medium and Facebook (gilgrimes) about whatever arises.  And if you would like to stay in touch sign up for my newsletter (probably once or twice a month at most).