Wired to say "yes"—Part 1: The inner game

Most veterinary professionals are highly skilled at saying yes, and it may come at a greater cost than many realize. In this first episode of a two-part series, cohost Jennifer Edwards, DVM, ACC, CPC, ELI-MP, goes beneath the surface of burnout and overaccommodation to explore where the inability to say no actually comes from. Spoiler: it starts long before veterinary school. For those who have felt guilty for having limits or wondered why saying no can feel threatening, this conversation is where that story starts to make sense.

Below is a partial transcript, which has been lightly edited for improved clarity.

Jennifer Edwards, DVM, ACC, CPC, ELI-MP: You spend all the years in high school and college preparing yourself to have a good application to be a good candidate, and then that process of getting selected to enter veterinary school is where the profession first kind of digs its little claws into those personality traits and gets a hold of that wiring and starts to amplify it. In order to get into veterinary school today, a person really needs to be exceptional. So, the GPA, the extracurricular activities, the experiences they may have had, the letters of recommendations, all of it—we have to come with this package, this resume already before we even start professional school. And often what is said in years earlier is the 'I will do whatever it takes, I'm going to vet school, this is my goal, nose to the grindstone.' Here I go, and so saying no doesn't really even occur to us as an option. It's more of a liability. I cannot say no to any and all of these things that I have to do to get selected.

So fast forward, we get selected, and now we're in school, and now it starts. Now we're near and surrounded by and in classrooms with all of the other people who also were exceptional and also were able to get into veterinary school. So the bar that we were living up at this high level just got raised again, and so now you got to keep up. You can't say no, you're going to fall behind, you're going to stand out in the bad way. You don't want to be the difficult one, and the sheer—gosh, I think back to vet school—the sheer volume of what is required to know to be able to do the medicine, and it just keeps advancing. It's honestly kind of mind-blowing, and so again [it] continues that ‘nose to the grindstone’ mentality: “I'm going to shut up and cooperate. It's just say yes, do what I'm told, do what I got to do,” because it becomes about survival at this point.

So we're not really [following] an ambition [anymore]—I mean, we are thinking ahead to that residency, that internship, whatever, but it's really a form of survival.

So we get through. Four years goes by, we get through, then we graduate, and then after all the studying and learning, we come to find out that we know nothing, and the real learning begins, and we go, 'Oh boy, okay.' And then the pressure comes. So we have the job, we have the expectations, the clients, we have all of this pressure now that's come upon us as a new grad, and again we start to now marry our self-worth with knowledge and skill, and the ability to now figure it out in the moment. And so we often in this profession are a little bit on the perfectionist side, because we're selecting for that.

Well, now guess what? Perfection is not possible, especially in vet med, and we may have a patient die, we get a diagnosis wrong, or we just miss it completely. We didn't even think of it. Complication happens after surgery. We put a bandage on too tight, and the leg comes back all swollen. Whatever, I mean, the list can go on and on and on of extraction side dehisces, and that's all reality that not only is going to happen, but even before it happens, there's a fear—a big fear of it happening—like, 'Oh my gosh, what if I fill in the blank, I harm an animal, something happens,' and then there's the fear of judgment: judgment from the client, judgment from our colleagues, client reactions, board consequences.

So imagine just this pressure upon pressure upon pressure building up. Standing up and saying no and really thinking about what works for us in that moment may not be at the forefront of what's going on. So the profession asks a lot of us, but it doesn't just ask a lot, it's actually selecting for people who are already inclined to just give everything and to just give and give and give, and then that identity that it's selected for is reinforced every step of the way throughout the career. And so the result is what we end up with is that accommodation and overperformance, which I think a lot of veterinarians can resonate with, it becomes really the safest way to be, the safest identity to inhabit. I'm just going to smile and say “yes,” and so when you say “no,” it almost becomes a threat to our identity. It's not just job security, which it may be, but it literally starts to threaten how we see ourselves, like who we see ourselves as being in this world, and that's hard to overcome