I am writing this article on reflection after a busy Monday, and if I had to identify the single most important thing that kept me on track today it was my ability to say No.
My Mondays start at 8am because that’s when the surgery doors open, the phones start to ring and soon after the walking wounded arrive. In a practice of 14000 patients an average Monday brings well over 600 telephone calls, the doctors call back and triage (sort) the majority of these calls their aim is to help and advise the patients the best they can, some patients are given advice, some patients are seen as an emergency and some patients are booked an appointment to see a doctor or a nurse at an appropriate time in the future.
In the background behind the ‘melee’ there are over 4500 requests for prescriptions each month, there are a variety of nursing, chronic disease, travel, immunisation, antenatal clinics, and other specialist clinics goings on at any one time. Administration work is also substantial too, every letter, note, result and report we receive is scanned, attached to the patient’s medical notes and sent swiftly to the appropriate doctor to action, and on any one day there is also a significant managerial and leadership presence working at a more strategic level to keep the team focussed, directed and confronting any problem as it arises.
On a busy day its easy to sidetracked by something or someone, it’s easy to lose focus, it’s easy to be diverted by an email a phone call, or a request for something that is not important, the ethos of the team at anyone one time is to do what’s most important; whether it be to meet the demand of unwell patients, see who needs to be seen, whether it be to sign routine prescriptions, check blood results, process letters or write reports and fill in requests and forms.
Saying no means that we learn how to sort, we stay productive and we save time to do what needs to be done.
The only way this whole operation can be maintained is to make sure that there are automated processes that keep the box 2 jobs (important but non urgent) ticking over, so that if someone with an urgent and important condition staggers through the door struggling to breath we can drop everything else and give them our immediate attention.
In the old days patients used to make an appointment with their doctor, whatever their problem, whatever their need, to pick up a prescription, to get a sick note, or even just for a monthly chat, in this old fashioned system there was no sorting and no triage in the system, the patient dictated what the doctor did most of the time, and it often meant the sick didn’t get seen and demand wasn’t always met.
I learnt that saying no was the most important thing I could do to deliver effective care, that doesn’t mean we turn people away, in fact our access is better than most other practices, it’s just that we have systems in place that make sure that the doctors are doing the most important tasks, and that means saying no to other things.
Saying no means we don’t do the things that can wait until after the important things are done, saying no allows you to stay on track and be more productive, to see the sickest, to see what you need to see and to keep at bay the unnecessary and to keep out he who shouts the loudest.
Systems need to be in place to automate the non urgent things, to prevent rash decisions, to prevent overload and to prevent decision fatigue, these systems make saying no easier because a system tends to get things done more effectively more efficiently and without error.
If done correctly saying no is positive, it means boundaries are set, it means feedback is given, it means people are educated, it means other people take responsibility, “the art of leadership is saying no” (Tony Blair).
In life there are always things to do, people are always requesting more of your time, people are always trying to take you away from your agenda to help them with theirs.
“When you say yes to others make sure you’re not saying ‘no’ to yourself” (Paulo Coelho),
Whatever you do, to stay focussed the most important thing is to say is no, saying no is one of the most important lessons you will ever learn, saying no sometimes means you are saying yes to success and happiness.
Dr Jeff Stoker.