In the Surgery: Assertiveness and Saying No

Saying no and being assertive is a skill to be learned and can often feel difficult for doctors who feel their primary aim is to care. Saying no can sometimes feel at odds with this. However, with the overwhelming demands that face general practice, learning to appropriately say no and be assertive is essential to manage these demands.


  • Use “I” Statements such as I WANT or I FEEL
  • Change Your Verbs: changing the verbs you use can make a real difference in assertive communication. “Will” instead of “could”. e.g. ‘I WILL be leaving on time tonight so I WILL NOT be taking on any extra work this afternoon, “want” instead of “need,” “choose to” instead of “have to.”
  • Give the good news. ‘I can’t get this done for 6.30pm but what I can do is give it my top priority tomorrow’.
  • Empathy: empathise with and recognise the other person’s point of view – ‘I hear that you are finding meeting this deadline difficult, let’s see what we can do about it’.
  • Stop apologising and using negative statements. Look at your emails or how you communicate. Do you apologise a lot? Use ‘sorry to bother you but…’ Take away the apologies and the negative statements and see what happens. Instead of ‘I’m so sorry, my printer has broken, I’m totally rubbish and hopeless, please can someone help me’, try ‘I want some help with my printer, it has broken again’.
  • Zip your lip and Buy some time: ‘And’ can be easy to say too much or offer explanations that confuse things. Say what you need to concisely and leave it there – ‘zip your lip’! Sometimes you need time to think about a request or what you want to say. Buy yourself time ‘You’ve caught me on the hop there, let me get back to you on that when I’ve had a think about it’.

Saying No

Saying no can be liberating as well as leading to reduced stress, increased self esteem and control. The first barrier for many people is to overcome the fear of saying no and the thought that you are being negative or obstructive by saying no. Are you a people pleaser and find yourself saying yes to everything to the detriment of your own wellbeing? Do you say Yes at the expense of yourself?

When responding to a request think about the value in it for you, the request may be of benefit and you may wish to say yes. Also, think about how much you value yourself and your time and learn to say yes to the things that are going to bring benefit to your life and wellbeing and reduce your stress.

Here are some useful strategies for saying NO:

  • Say yes to the person – No to the task – This takes a three-pronged approach: EMPATHISE, SAY NO, AFFIRM: Empathise with the person – ‘I know you were hoping I would…’ ‘that sounds like a great opportunity…’ I really appreciate you asking….’ ‘that sounds like a tricky situation….’
  • Say no – keep it short and direct, don’t offer explanations unless you want to, explanations often invite negotiation, don’t apologise. ‘Under other circumstance I would have loved to’, ‘unfortunately on this occasion I will have to decline’, ‘as a general rule I don’t…’
  • Affirm the relationship by thanking them and saying something positive. ‘I realise this project is important to you and I’d love to help, but on this occasion, I will sadly have to say no. I know you will be brilliant, please let me know how it goes and thank you for asking me/please do think of me in the future.’
  • The negotiator’s no – Yes I can do that if…
  • Yes I can help with the extra workload IF you can organise someone to attend my meeting for me.
  • The buying time no – Let me think about that/check my commitments and I will get back to tomorrow/next week/next hour.


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