It`s Okay To Say No

The past week or two has taught me a hard but honest lesson. When starting out in practice like most new, young physicians, I was (and still am) eager to take on and do everything that I can to build my practice and patient following, establish a name in the field (locally and beyond), set forth my own agenda and goals in the field now that I am free to do so and so on.

However, sometimes trying to do and take on everything, even at such a young phase in my career, may not be the best of decisions. Both for my patients and for myself, I am still trying to find that balance.

The first realization I had was "It’s okay to say no and not want to treat certain patients." For my specific situation, my office tends to get a good amount of pediatric pathology with ages all the way down to 4 and 5 years old. While I had some experience with this population during my residency and fellowship, I still feel at times not fully equipped to treat children, especially those in the lower age ranges.

Speaking to similar-aged colleagues about their office population while at the recent American Podiatric Medical Association (APMA) National event, they have the same sentiments about other pathology: trauma, reconstruction, the diabetic population and so on. We each have our own strengths and weaknesses based on past experience, training and interests in this varied field of podiatry where one can specialize and focus the practice in certain areas. There are many other physicians with more years of experience or practices, specifically around my geographic area, who specialize in pediatric foot ankle conditions. Just a stone’s throw away are two large pediatric hospital institutions as well as five physicians designated as specialists by the American College of Foot and Ankle Pediatrics (ACFAP).

It’s okay not to want to treat everyone and I should not feel ashamed or inadequate as a result. I should feel confident in my decision and ability to get the patient to the right physician for appropriate treatment.

The second instance I had was “It’s okay to say no when asked to help.” I enjoy partaking in academic related work outside of the office. Whether it is DPM Blog entries such as this, case reports and papers in collaboration with the residencies I work with, giving presentations to the local programs and so on, I have always liked to do as much as I can in this space.

Recently while at the APMA National meeting, somebody asked me to partake in a few more opportunities related to the aforementioned projects. Again, wanting to put my hand in every pot, I spoke with one of my mentors about it. While encouraging but already knowing what pot(s) my hand(s) were in, he gave me the advice (sparking the reflection for this entire blog entry) not to make the “same mistake” and spread myself too thin. His words were short and honest: “It's okay to say no.”

I realized at this point for the most part I have not done that. There is a delicate balance to keep us motivated and sane in our multiple lives (i.e., work, social, family, personal). I was starting to get to the point of feeling overwhelmed. I was working on a few presentations for an upcoming lecture, these monthly DPM Blogs, projects with the residents and a few other items all while still trying to build my practice and get married this October. I realized he was right and I needed someone telling me “It’s okay to say no” in order to have an honest reflection of everything I was trying to do.

Albeit two different instances, I have taken this advice to heart in both. It is helpful every once in awhile to turn it off and catch your breath, regardless of the stage of your career. It’s important to realize that saying “no” is not a reflection of the kind of doctor you are (while it often makes me, anyway, feel inadequate). If anything, it shows a thoughtfulness and maturity to be able to have that self-reflection regarding your strengths and weakness, likes and dislikes, capacity and limitations in a search to understand who you are.

Dr. Hood is a fellowship-trained foot and ankle surgeon. Follow him on Twitter at @crhoodjrdpm.