The Most Important Word

April 4th, 2013 By Steven Knope, MD

I was recently asked to give a talk to a group of doctors who were frustrated with their professional lives. They were attending a conference called Medical Fusion, where they would be exposed to a group of colleagues who had somehow found professional job satisfaction. Because I had authored Concierge Medicine, I was asked to be among the speakers and explain how I had found a way to break free from the system.

After accepting this engagement, I made the decision that I would not play the role of Tony Robbins or Dr. Phil. I am no fan of motivational speakers. I don’t have a canned speech and I am skeptical of recipes for success. Instead, I decided to spend some time thinking about why these professionals were trapped and what I might say to help them.

While getting dressed for work one morning, the topic of my talk came to me. I realized that the fundamental weakness of these otherwise strong people was clear: They did not know how to use the most important word in the English language.

I started my talk by picking 4 people out of the audience. I put them in chairs next to me on stage as my panel of experts. I selected a diverse mix of people. I picked a huge body building surgeon, a meek appearing dermatologist, a man who looked me straight in the eye and a woman who desperately looked away, hoping that I would not pick her for the panel. Once on stage, I asked each of them this simple question: “What is the most important word in the English language?”

Love, Hope, Perseverance, Family…

Before the talk, I had field tested this question with several unhappy doctors in Tucson. They offered words like “love, hope, perseverance, and family.” When I asked the same question to the doctors at the conference I got similar responses.

I decided to reword my question and asked, “What is the most powerful word in the English language?” Still, no one got the answer. I then asked, “What is the first word a child learns?” Finally, a soft spoken Indian man in the front row said, “No.” I asked him to repeat his answer a little louder so that everyone could hear it. He said, “The most important word in the English language is no.” YES, I cried. The answer is NO!

Why “no?”

The audience sat there puzzled. Why was the word “no” relevant to their dilemma or this conference? How could “no” be more important than love, compassion, caring, or optimism? In truth, “no” is no more important than those other words, depending on the situation. However, if you are striving to attain personal or professional autonomy – if you want to live life on your terms – you MUST be able to stand firmly on principle and say “no” to those who would take away what you have worked so hard to attain.

These physicians had been indoctrinated throughout their training and careers to worry about what other people thought of them. It wasn’t that they “cared” too much. They were afraid of what other people would think of them if they fought the big insurance companies, Medicare, or the other forces that threatened their autonomy. Their patients might think they were selfish if they opted out of this system that enslaved them. They felt trapped.

I then pointed out the most basic laws of nature: As soon as you have something worth taking, some person, some animal, or something thing is going to try and take it from you. In these situations you either fight for yourself or you let the predator take what is yours. In the doctors’ case, that thing worth taking and controlling was their very profession. The control of medicine means big money for big insurance and power for politicians. These doctors, like most, have allowed themselves to become pawns in a big game of chess. It is a self-inflicted wound.

Children and the word “no”

So what does this word “no” really have to do with your happiness and success? We all have to live, work, and operate in groups. We have to cooperate with other people to survive. But if we surrender our individuality, if we allow others to control us, we trade service for servitude. The word “no” says, “These are my boundaries. This is where I start and you end. Do not cross these boundaries or you will meet resistance.” Without these healthy boundaries, you lose control over your life.

The gift of saying “no”

If this concept seems selfish to you, ask yourself if you trust a “yes man?” My most trusted friends are people who can and do disagree with me. On the occasions that these people do agree with me it actually means something, because I know that they are not afraid to disagree.

On a societal level, the inability to say “no” spreads like an insidious virus. It creates the kind of political correctness that we are now facing in this country. It weakens the people who have the unique education and ability to protect us, like doctors. When those who are supposed to be our advocates become frightened, we all suffer.

“No” doesn’t mean being a jerk

It is important to clarify that by saying “no” I am not implying that people should be obstreperous jerks. There are many situations in which you can say no in a polite and cordial manner. You can say “no” with a smile, or by using body language. In other situations, you need to say “no” with every fiber of your being, but it does not mean that this is a personal attack. It means, “You are invading my personal space.” Stop.

Difficulty in saying “no” is not just a problem for doctors

I have shared this topic with you because in my experience as a physician, I am frequently asked by patients for advice when they are struggling with difficult personal situations. This often occurs during a conflict in an important personal relationship. A person may feel stuck in a bad marriage. They may have a problem with a difficult child or a controlling boss. In many of these situations, people have developed a fear of disagreeing – of saying “no” to a person– and this pattern has finally reached a critical point where it is doing damage to them as an individual. Their thoughts are tied up in knots because they have lost their ability to psychologically defend themselves. All of us have been in such a situation at some point in our lives.

Even if it does not feel natural to do so, it is important to make yourself say “no” when someone or some institution is exhibiting predatory behavior. This simple act of saying “no” is the beginning of regaining your freedom. Each time you say “no” in a difficult situation, or to a powerful person, you get stronger. Each time you fail to do so, you lose a little piece of yourself. And if you lose your ability to say “no” over the long term, you may find yourself paying for an expensive seminar someday to have someone to tell you what you once knew instinctively as a two-year-old.


One response to “The Most Important Word”

  1. Kathryn Forte writes:

    I’ve wondered for a long time why people in our country seem so docile, when all my husband and I can do is yell NO! at the television screen on those occasions when we watch the news and other programs. So many blatant errors, so many sensationalistic mini bites, so many trashy values, yet so little perspective, so little wisdon, so little knowledge of our history, of how far we have come, and what our conntry has contributed to the world. Several people I know have said a definitive NO by giving up TV and the press completely.

    This article in The Pearl made us want to say NO again, not only to the media and the press, but also to our current system of crony capitalism and our elected officials, and YES to the need for more assertiveness by the rank and file American people. Has our culture just gone soft, crippled by its good intentions and its own success? I agree with Dr. Knope that this is so.

    The article struck a nerve when I forwarded it to friends. One replied that it was “brilliant, simple, effective, difficult, challenging and liberating.” People of all political persuasions appreciated the message. Maybe a wider call to NO is just what we need. It certainly is what physicians need.

    Larry Summers, well known economist, wrote: “A good rule of thumb for many things in life holds that things take longer to happen than you think they will, and then happen faster than you thought they could…”

    Let’s hope that the chorus of NO takes the country, sooner rather than later.

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