How to say NO (for people pleasers)

How to say NO to people pleasers

People pleasers are dangerous. They actually end up hurting people. Don’t be too nice anymore. Here’s how I recovered—and you can too! Listen in . . .

Check out the letter I just received:

Hi Pamela, I’m slowly making changes, but every day is a struggle. Part of my challenge is simply saying NO. I had a major breakthrough last week. My prior employer wants me to interview for another “job”…. I’m asking more questions before agreeing to go….like send me a job description/title and let me speak to someone about the current needs of the practice before making me drive over 3 hours on my vacation day!! Give me some specifics!! It’s been 7 days since I asked and I’ve yet to get a response. If you can’t answer simple questions then I don’t think I want to work for your organization! It sounds so dumb but it’s hard to say NO when I’ve been conditioned to be a YES person. It’s like they say jump and I say how high? It’s unfair and exhausting so I’m taking back control over my life NOW! ~ Erika

As doctors we’re used to being the straight-A valedictorian presidents of every club and organization. We’re people pleasers who submit to authority and we’re such do-gooder super-achievers that we tend to take on way more than we can handle. Saying no is a learned skill. Practice it now. In a mirror. With your kids, spouse, patients. To inspire you, here’s how I say no in my medical clinic:  (feel free to steal these)

1) I say no to medication refills between appointments. More than 30% of calls to my clinic were related to prescription refills. No more! I say no to any patient or pharmacy requesting a refill outside of an office visit. I clearly state this in my office policy on my outgoing phone message. If a pharmacy still leaves a refill request on my phone line, I simply press delete (best feeling ever!).

2) I say no to angry men who yell during office visits. After divorcing my ex who had anger management issues, I’ve decided that anyone with an anger problem should seek help from a specialist in anger (not me). Don’t project your anger at your boss, wife, or mother onto me. I will not tolerate any loud, hostile men in my life. 

3) I say no to charity care (yet I’ve never turned any patient away for lack of money in 12+ years). Medical care is not a passive experience. I expect patients to be actively engaged emotionally, physically, and financially. I give 110% to my patients and I expect an equal energy exchange in return. In the rare case that someone is truly unable to pay, I require that they donate their time to the community (soup kitchen, animal shelter, etc) just as I’ve donated my time to them.

4) I say no to assembly-line medicine. I didn’t invest decades of my life to become a caring and competent physician only to be held hostage in a big-box clinic seeing patients every 7-10 minutes. So I quit and opened my own ideal clinic where I see patients for 30-60 minutes (plus now I earn more too!).

Want to say NO to assembly-line medicine? Join our call this Sunday.


Boycotts & Microstrikes

Saying no has made my life awesome! Imagine if we all learned to say no. When large groups of people say no, governments, employers, and organizations respond. Plus the media loves it too!

Anytime you withdraw your participation or relationship with an organization or refuse to cooperate with a policy or job description, you are boycotting something. Boycotts create culture change—quickly. Think about the far-reaching impact of the bus boycott (when Rosa Parks said no she would not give up her seat). Withdrawing revenue (or revenue-generating employees) from a business in a capitalist culture is a sure way to get action. 

When employees refuse to work as a form of organized protest, a boycott becomes a strike. In the UK this past year junior doctors were on strike due to unsafe/unfair working conditions. The senior doctors supported them and so did 54% of the general public. No patients died as a result. A well-planned strike creates culture change—even in medicine—and without harming patients. In the US, I don’t predict an all-out physician strike; however, each doctor who says no and refuses to participate in for-profit insurance, corrupt organizations, or medical institutions that violate the human rights of their workers is essentially a microstrike. In large numbers, microstrikes take down entire industries. Just watch.

People pleasers actually hurt people 

By saying YES to corrupt organizations or employers that violate human rights of their employees, you are actually harming yourselves and others. The cycle of abuse in medicine is perpetuated by people pleasers who won’t say no. So congratulations! By saying no you are healing not only yourself. You are healing our wounded profession, your patients, and your community. Thank you!

When should you say no? Do share . . .

Need help? Join our recovery program for people pleasers.


Pamela Wible, M.D., is author of Physician Suicide Letters—Answered and Pet Goats & Pap Smears. She reports on human rights violations in medicine and hosts biannual retreats to help her colleagues heal from their trauma.

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9 comments on “How to say NO (for people pleasers)
  1. Cyb says:

    So glad the MDs/hospitals/clinics I deal with don’t ignore my prescription refill requests. I should send flowers. Bless them truly.

    • Pamela Wible MD says:

      Yes, there is so much work done on behalf of patients that is never actually witnessed (or paid for) by those who receive our care.

  2. Lisa E Goldman MD MSW says:

    Love it!!!

  3. Dino says:

    Don’t forget that calls for med refills are a defect in your system. If I need to see someone in six months, why wouldn’t I make sure get have enough meds for six months before they leave the office?

  4. Shannon Tapia says:

    Thanks for this! I am a Geriatrician in between jobs right now (I said NO to being taken advantage of by the highly dysfunctional and sexist department I was part of in Academia and resigned). I’m torn between opting out of medicare and starting a consultative practice solo and another system in the area that has said they want to give and create a job just for me but is terrible at communicating. Financially at this point in my life I’d rather be employed…..but I wonder if waiting for this other institution who is terrible at communicating is just letting them take advantage of me. I’m not sure what to do, but I do know this…….I think more docs should opt-out of medicare as it is the worst offender of unfair practices. Medicare does not value time, it values dangerous procedures or even simply unnecessary ones and is bankrupting our country. Too many Geriatricians are “Yes” people to a fault though and that’s why the field is dying.

  5. Samantha says:

    Case in point: Hospital flu vaccine mandates for employees. CMS has unethically linked a 90% annual employee vaccination rate to reimbursement. This has created a curious oxymoron known as “Mandatory Consent”. Ethics teach us that, consent achieved by intimidation or coercion (i.e. “no job”), is not valid consent. If we allow ourselves to be treated by our employers in a way we would never treat our patients, we are failing ourselves, and by extension, our patients.

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