A few years ago, in the depths of my own burnout, I finally booked an appointment with my psychologist. I had scheduled it almost a month in advance, not because I decided it could wait, but because that was my next free day.
I had agreed to do a lot of things before then, and in fact, I kept piling tasks on until ultimately the decision was taken out of my hands entirely and I ended up needing to take extended leave from work. Ironically, leaving me with much more time at my disposal to finally make it to that psychologist appointment.
I wrote more about my burnout in a separate article, but today I wanted to talk about the cost of your “yes”, and what it might mean for your health and professional longevity.
The “Yes” as a Default
Most of us learned early that a good doctor is someone with a strong sense of responsibility, high standards, and a willingness to push through difficulty. In fact, these traits are exactly what medicine selects for and rewards. We carry these into everything we do, and the ability to constantly rise to the challenge and say “yes” to all requests, can slowly become part of who we feel we are. I ‘can’ do it, so I ‘should’ do it.
There’s nearly always a good reason to say yes- a colleague needs help, there’s a gap in the roster, or another patient needs to be seen before clinic closes. None of these are small things, and none of us want to be the person who says no to something important (as many things can be in medicine).
Over time though, ‘yes’ tends to become the easier response than a careful and considered ‘no’. With that familiarity, it can become more difficult to discern the difference between what is in our capacity to do, and what is simply within our skill set to achieve. As capacity stretches thinner and thinner, boundaries we thought we had set move a little further out each time, until we’re not entirely sure where they sit at all anymore.
We can cognitively understand that every yes we give to one thing is also a no to something else, but it is entirely different when we actually have to practice it ourselves.
Sometimes it’s the people at home. The dinner missed, the school pickup someone else quietly covers, the partner who gets whatever is left of the day once everyone else has had their share of you.
Sometimes it’s you. Rest, exercise, the friendships and interests that make life feel like more than work, these are usually the first things to go, and they tend to go quietly enough that you don’t notice until they’re mostly gone.
No can also feel much harder to say and much heavier to hold as it often comes with other feelings, like guilt, fear of missing out, worries and anxieties about missed opportunities.
So we choose the resentment of a begrudging ‘yes’ in favour of the heaviness of a difficult ‘no’.
What this doesn’t mean
None of this is an argument for never helping, or never being flexible in our profession. Medicine runs on people who show up for each other, often in moments that genuinely can’t wait.
It’s an acknowledgement that the ‘no’ that exists at the boundaries of your capacity, needs some thought and consideration before it is needed in the heat of the moment, AND about having enough left in reserve to actually make that choice, rather than just defaulting to yes. There’s a real difference between being stretched because you’ve decided to, and being stretched because you’re out of other options.
Sitting with the discomfort of saying no, even briefly, is often what creates the room to say yes later, on your own terms, when it genuinely matters.
So where do we start?
If yes has become automatic, the first practical step isn’t learning to say no. It’s learning to notice that there’s a choice at all.
I often come back to the image of a sailor. Before deciding how to trim the sails, a good sailor reads the weather, the state of the boat and the state of the captain, then acts accordingly. None of those things are fixed. The same boat that can carry full sail on a calm morning needs reefing when a southerly comes through. Our capacity works the same way. What was entirely reasonable to take on in a quiet month may be too much in a week with three nights on call, a sick child at home and a difficult death of a patient. I think of this as a dynamic awareness of self and state, and it’s the foundation that makes everything else here possible.
These are a few ways to build it that I’ve found genuinely useful, both in my own life and in the rooms I’ve shared with doctors over the years.
- Check the weather before the request arrives.
Take a few minutes at the start of each week, perhaps with your diary open, to ask yourself how full you actually are. What’s already committed? What do you need to protect this week to still be functioning by Friday? If you name two or three non-negotiables in advance (the school pickup, the Thursday swim, the night you’re home for dinner), you don’t have to work out where your boundary sits in a corridor with a registrar waiting on an answer. A calmer version of you has already made the decision. - Put a pause between the ask and the answer.
So many of our yeses happen in the half second after the question… before we’ve consulted anything other than habit. A simple holding phrase can give you back that choice: “Let me check what I’ve got on and come back to you this afternoon.” It’s honest, it’s professional, and it turns a reflex into a decision. You may still say yes, but it will be a yes you chose. - Ask what this yes is a no to.
When you’re weighing something up, it helps to make the trade visible, out loud or on paper: “If I say yes to this, what am I saying no to?” Sometimes the answer is nothing much, and the yes is easy. Sometimes it’s your sleep, your partner, or the one evening this week you’d set aside to do nothing at all. Seeing it named can change the decision. - Remember that yes and no aren’t the only options.
There’s a lot of useful ground between a full yes and a flat no. “I can’t take the whole shift, but I can stay until six.” “I can’t join the committee this year, but I’m happy to review the draft.” “Not this month, but ask me again in February.” A partial or reshaped yes lets you stay the generous colleague you want to be without overdrawing an account that’s already running low. - Treat resentment as information, not a character flaw.
When you notice the familiar tightness of a begrudging yes, it’s worth getting curious about it rather than pushing it down. Resentment is often the first signal that a boundary has been neared or crossed, usually well before exhaustion makes it obvious. Curiosity is the precursor to compassion, and a gentle “what is this feeling trying to tell me?” is far more useful than another round of telling yourself to just get on with it. - Let guilt be present without letting it decide.
Guilt after saying no is common, especially in a profession built on service. It doesn’t necessarily mean you’ve done the wrong thing. Often it simply means you’ve done something unfamiliar. You can feel it, acknowledge it, and still hold your decision. Like most discomfort, it tends to soften with practice.
This isn’t only an individual problem
It would be disingenuous to suggest that better personal boundaries can fix a roster that is chronically short, or a system that relies on goodwill to plug its gaps. If you find yourself saying yes to the same gap again and again, that isn’t a personal failing to manage. It’s a pattern worth naming with the people who have the power to change it. Some of the most meaningful ‘no’s’ are collective ones, and part of protecting our own longevity is advocating for workplaces where saying no doesn’t leave a colleague, or a patient, stranded.
Coming back to that appointment
I still think about that psychologist appointment, booked a month out because every day before it had already been given away. I didn’t run out of time because I was disorganised, or because I didn’t care about my health. I ran out of time because, one reasonable yes after another, I had given it all to everyone else first.
You don’t have to wait for the decision to be taken out of your hands. This week, I’d invite you to try just one of these. Notice one yes before it leaves your mouth. Pause, check the weather, and ask what it might cost. Then make the choice that is genuinely yours.
If you’d like time and space to explore this more deeply, alongside other doctors who understand it from the inside, our CPD-accredited retreats are built for exactly this kind of reflection. So, if this is the kind of space you’ve been needing, you can explore our 2027 retreats here.