The Power of NO

I originally wrote an article on ‘The Power of No’ after reflecting on a busy Monday-morning triage session. If I had to identify the single most important thing that kept me on track that day, and the single most important thing that allowed me to be most productive in my efforts, it was my ability to say no. Not maybe. Not later. No.

Typically, my Monday mornings started at 8 am. That’s when the surgery doors open, the phones start to ring, and the sick and the walking wounded stagger into the waiting room. In a practice of 14,000 patients, an average Monday brings hundreds of telephone calls. The doctors call back and triage the majority of these calls. They aim to help and advise the patients the best they can. Some patients receive advice; some are seen as emergencies; and some are given appointments later in the week at a more appropriate clinic with a more appropriate person.

Amongst the melee of a Monday morning, there are thousands of requests for prescriptions to be issued and signed each month. There’s the usual plethora of other paperwork, there are the results of tests that need looking at each day, the daily bundle of letters from specialists to be read, or for specialists to be written, and then there’s the other stuff that pops up during the day from the chronic disease clinics, or when an opinion is needed. It never stops.

Every letter, note, result and report the practice receives is scanned, attached to the patient’s medical notes and actioned. On any one day, there’s also the need for significant managerial and leadership presence, giving direction and working at a more strategic level to keep the team directed and well-led. Without leadership, the whole thing falls apart. Without saying no, I’d never have time to lead anything.

On a busy day, it’s easy to be 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 unimportant. The urgent drowns out the important. The squeaky wheel gets the grease. Often the person who shouts loudest gets seen first, even when they’re the least sick.

In the front line, you lose the strategic picture. You see only the urgent or what only seems urgent at the time. To stay productive and deliver effective clinical care, you need to be able to say no to that which is not important. That doesn’t mean we turn people away. In fact, at that time, our access was better than most other practices. It’s just that we have systems in place to ensure doctors focus on the most important tasks and avoid what they don’t need to do.

Saying no means saying no to the things that can wait until after the important things are done. Saying no allows you to see the sickest, to see what and who you need to see, and to keep at bay the unnecessary or he who shouts the loudest in preference to seeing the patient too breathless to finish a sentence. Without NO, the loudest voices win. With NO, the people who actually need help do get it.

Saying no is a positive thing. It means boundaries are set, important things are done first, time isn’t wasted on trivia, and responsibility is returned to those who should really be doing these things for themselves. You’re not being selfish. You’re being strategic. You’re being effective. You’re actually helping more people by helping the right people.

Time is a constant. What I mean to say is there are only so many hours in a day, and when there’s always work to do, there’s only so much you can do, so prioritisation needs to happen, and that means saying no. You can’t do everything. You can’t help everyone. You can’t be everywhere. Pretending otherwise is delusional, and it’ll destroy you.

Tony Blair had a point when he said, “The art of leadership is saying no, not yes. It is very easy to say yes.” He was right. Saying yes makes you popular in the moment. Saying no makes you effective in the long run. You need to choose which one matters more to you.

There’s a point in your work and in your life when, if you want something to happen, and you want to be more productive, you need to start saying no. There’s a power in saying no. Our time is finite, too. Sometimes, to say yes to ourselves, we also need to say no to others. This isn’t selfish. This is survival.

This course is about cognitive biases. There’s Reciprocity Bias, which is the conditioning we feel we have to help others who have helped us. There’s Acquiescence Bias, which is the tendency we have to agree to do something when we’re in doubt. And there’s Social Desirability Bias, which is when we do things to look good in front of others. All of these biases, and the fact that you’re probably a really nice person or that you just want to help others or just get others to like you, will push you to say yes when you should say no.

These biases are not your friend. They’re making you exhausted, overwhelmed, and ineffective. They’re making you say yes to things that don’t matter while saying no, by default, to the things that do. Every yes to something unimportant is an automatic no to something important. You just don’t realise you’re doing it.

There’s strength in a well-considered no. Some people don’t say it enough. Yet we’ll always meet people who take more than they’re due, and no stops them in their tracks. The influence of a bully stops when enough people say no. A no gives us space, it prevents overwhelm, and it prevents overload. Without no, you’re at the mercy of everyone else’s priorities.

No is not an excuse. No gives you the gaps in your life that you need for growth. The power of no gives you the time you need to do the important things. It’s not about being difficult or uncooperative. It’s about being clear on what matters and protecting it fiercely. If you can’t say no to what doesn’t matter, you can’t say yes to what does.

I see people who are exhausted, burned out, at the end of their rope. They’re working themselves to death trying to please everyone, trying to help everyone, trying to be everything to everyone. It’s killing them. Not slowly, either. Quickly. And when I ask them why they don’t just say no to some of these demands, they look at me like I’ve suggested something impossible.

But it’s not impossible. It’s necessary. You’re not going to collapse from saying no. You’re going to collapse from not saying it. The people who make the biggest demands on your time are often the ones who contribute the least to your life. The people who respect you will understand when you set boundaries. The people who don’t respect you never will, regardless of how much you sacrifice for them.

Here’s what you need to understand. Every time you say yes when you mean no, you’re lying. You’re lying to them, and you’re lying to yourself. You’re pretending you have time you don’t have. You’re pretending you have energy you don’t have. You’re pretending you can do something you can’t do. And then when you fail to deliver, or you deliver something substandard because you were too stretched, everyone’s disappointed. Including you.

Saying no from the start is kinder. It’s honest. It’s respectful to both parties. It says, “I can’t give this the attention it deserves, so I’m not going to pretend I can.” That’s not selfish. That’s integrity. That’s being clear about your limitations and honouring them, rather than ignoring them until you break.

The power of no is the power to choose — what you work on, who you help, and how you spend your time. If that framing sounds familiar, it’s because I’ve borrowed it from William Ury’s The Power of a Positive No, which makes much the same case: a clear no is what protects a meaningful yes. Without no, you’re just reacting to whoever shouts loudest, whoever makes you feel guilty, whoever puts the most pressure on you. With no, you’re in control. You’re making decisions based on what matters, not based on who’s most demanding.

Start practising no. Start small if you need to. No to the meeting that doesn’t need you. No to the favour that someone else can do. No to the project that doesn’t align with your goals. No to the person who always takes but never gives. Each no gets easier. Each no creates space. Each no is a yes to something that actually matters.

Your life will not fall apart if you start saying no. The opposite will happen. Things will start working better. You’ll have time for what matters. You’ll do better work because you’re not spread so thin. You’ll be less exhausted because you’re not carrying everyone else’s problems on top of your own. You’ll be more effective because you’re focused on what’s important instead of responding to what’s urgent.

The power of no is the power to build a life that works. To protect your time, your energy, your priorities. To help the people who actually need help instead of the people who are just demanding. To do work that matters instead of work that’s just loud. It’s one of the most important skills you’ll ever learn, and if you don’t learn it, everything else you’re trying to achieve becomes infinitely harder.

Further reading

• Ury, W. (2007). The Power of a Positive No: How to Say No and Still Get to Yes.
• Cialdini, R. B. (2006). Influence: The Psychology of Persuasion.
• Cloud, H., & Townsend, J. (1992). Boundaries: When to Say Yes, How to Say No to Take Control of Your Life.
• McKeown, G. (2014). Essentialism: The Disciplined Pursuit of Less.
• Covey, S. R. (1989). The 7 Habits of Highly Effective People.