June 2, 2023

Being Assertive in Medicine: Free Yourself with a 2-letter Word

As physicians and other allied healthcare professionals, we can all take a page from the book of this famous tennis superstar.

Those of you who follow tennis will likely recall the infamous uproar caused by the twenty-three year- old Naomi Osaka in 2021 when she refused to participate in press conferences at the French Open, claiming that her mental health is more important. She made a stand to do something considered unthinkable by many of us in the medical field. She refused to sacrifice herself for her work. For that, she made headlines and suffered initial backlash. But for many others, their adoration and respect for her grew because it took courage, not weakness, to make such a stance. She reminded us that we always have choices, even when the demands of our work suggest we do not.

The moral of this story is that while we may love our work and make many sacrifices for it, but sometimes our work may not love us back.

Some of us entering medicine believe we need to be agreeable to demands from patients, lawyers, pharmacists, other physicians, administrators…. We want to be the Golden Retrievers of the dog world, loved by everyone. Rather than the opportunity to practice medicine as we envisioned it upon entering medical school, this is what we get:

“Doc, my lawyer wants a letter from you by tomorrow explaining how my mild fender-bender car accident has caused me to be to completely disable from working indefinitely”

“Please order this list of 30 blood tests and x-rays on our mutual patient because I am not licensed to do so.”

“Doctor, I feel a bit of nasal congestion starting to come on, and I want a prescription for an antibiotic


What issues are trapping you at work? Are you taking on more work than you can handle? Are you spending the entire day at work without taking a break? Are you being asked to do something that goes against your morals?

Being passive is allowing things happen to you rather than taking action. We become passive because we want to avoid conflict, but it ignores our own needs. It reduces our self-worth. We sometimes mistakenly believe that we are appeasing patients when we remain passive and comply with their unreasonable demands. In fact, it has been shown that acting in this way can backfire because it can lead some people to see us as pushovers.

Being assertive reduces our anxiety, allows us to earn the respect of others, and boosts our self esteem. It gives us the opportunity to come to a mutual resolution, instead of a one-sided winner-takes-all. This does not require us to be harsh or disagreeable.

Sometimes, assertiveness and aggression are incorrectly equated. Aggression involves shutting down the other person. The conversation becomes one-sided. It involves imposing one’s own viewpoint without taking other people into account. On the other hand, assertiveness means speaking your mind directly while remaining respectful.

Freeing ourselves with a two-letter word

So how do we escape this trap we’ve set for ourselves? The word is just two letters long: NO. This two-letter word can set us free, just like Naomi Osaka did last year.

We must constantly remind ourselves of the things we can control and those we cannot. We work on letting go of things that are out of our control. Yes, practise is necessary. But just like anything else, it gets easier with practice.

What if you are unable to identify anything under your control? Then remind yourself that the only thing you still have control over is how you respond, even if you have no control over the event or the other person. We can practise responding effectively so that we don’t just react. This is the essence of mindfulness training.

Two Circles of Awareness

When we are alone, we can envision ourselves with a circle of awareness. We can become aware of our thoughts, which lead to our emotions, which lead to our behaviours. However, when we enter into communication with someone else, there is a second circle: the other person’s thoughts, emotions and behaviour.

Two Circles of Awareness

Two Circles of Awareness

For effective communication, we need to become aware of not only our own circle of awareness, but also the other person’s. Rather than attempting to dominate the other circle or surrendering passively, we can seek to blend. When we begin to understand the situation from their perspective, this becomes easier.

As we undertake this, we must be mindful of our own emotions and triggers. Are you overreacting to their particular request because it has been made countless times before? Or are you unduly triggered as a result of having held in your rage on the same problem for the last three years? Recognize your triggers. Understand your own stress patterns.

Do not compromise your values, as doing so will cost you. It will slowly consume you like a parasite, until all that is left of you is a shell.

Although you have no control over the actions of others, you do have power over your own reactions. Keep it constructive rather than destructive. In this way, we maintain our center.

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