The Art of Saying Yes (When You Really Mean No)

By Julie Brownley, MD, PhD

Founder, Psychiatry for Women

Reproductive Psychiatrist

Toward the end of residency, I had one of those days.

Too many consults.

Too many competing demands.

Too little time to do any of it well.

I was on consult-liaison service, and general surgery had requested a “competency evaluation”. This is the kind of consult that feels like a cop out. We do all the work, they check the box. It wasn’t the first one that day. Not even close. I remember walking upstairs, already drained, probably looking exactly how I felt. One of the nurses pulled me aside.

“Hey hun, you look a little down. Everything okay?”

I told her the truth. That I was being asked, once again, to do something that didn’t really require psychiatry. That it felt like other teams were offloading work they could do themselves. That I didn’t feel like I could say no, even when it wasn’t appropriate.

She listened for a minute and then said:

“I want to teach you a trick. It’s called saying no by saying yes.”

Internally, I rolled my eyes.

But I stayed.

The Trick To Saying No by Saying Yes

What she described was simple, and surprisingly effective.

Instead of saying no directly, you say yes, but you control the timeline, the conditions, and the alternatives.

Something like:

“I’d be happy to help with this. I’ve triaged several urgent consults ahead of this one, so I’ll likely be able to get to it sometime tomorrow. If you’re hoping to move more quickly, I’m going to send you the capacity assessment framework we use, it's super easy and it’s something your team can complete independently whenever you like.”

Super friendly tone. No resistance.

But also — not a yes in the way they expected.

Why It Works

As a resident, saying no wasn’t really an option.

There’s hierarchy. There’s pressure. There’s the unspoken understanding that you are supposed to say yes, even when it doesn’t make sense.

This approach lets you:

• remain collaborative

• avoid direct confrontation

• set boundaries anyway

And most importantly, it shifts the burden of urgency back to the person making the request.

What Happened Next

It worked.

Not once. Repeatedly.

The consults that didn’t truly require psychiatry often… resolved.

Teams either handled things themselves or realized the urgency wasn’t quite as urgent as it felt in the moment.

And I didn’t have to say no.

This Shows Up Everywhere

I’ve used this strategy in countless situations since then.

And I see versions of this dynamic all the time in the women I work with.

Women who:

• feel like they can’t say no

• take on more than they should

• worry about disappointing people

• end up overextended and depleted

For many of them, the issue isn’t knowing they should set boundaries.

It’s not knowing how to do it in a way that feels tolerable.

What This Is (and What It Isn’t)

This isn’t about being passive.

It’s not about avoiding boundaries.

It’s about delivering a boundary in a way that other people can hear.

You are still:

• protecting your time

• clarifying what is actually your responsibility

• and setting limits

You’re just doing it without triggering unnecessary friction.

When It Works Best

This approach is especially helpful when:

• there’s a power differential

• direct “no” feels too charged

• you want to stay collaborative

• the request is flexible (even if it’s presented as urgent)

When It Doesn’t

There are times when a direct no is necessary.

When something is clearly inappropriate. When safety is at stake. When the boundary needs to be unmistakable.

This isn’t a replacement for saying no.

It’s a tool for when saying no isn’t straightforward.

A More Honest Take

Is it fair that we can’t always just say no?

No.

But in many real-world settings, especially early in training or in complex systems, it’s often more effective to work with the structure rather than against it.

This is one way to do that, without losing yourself in the process.

Final Thought

Sometimes the most effective boundary doesn’t sound like a boundary.

It sounds like cooperation.

If This Feels Familiar

If you find yourself saying yes when you don’t want to, or struggling to set limits without feeling uncomfortable, you’re not alone.

At Psychiatry for Women, this is something we work on often: helping women set boundaries in ways that are both effective and sustainable.

Because protecting your time and energy shouldn’t require constant conflict.

About the Author

Julie Brownley, MD, PhD is a psychiatrist specializing in women’s mental health and the founder of Psychiatry for Women. Her work focuses on perinatal mental health, hormonal transitions, and helping women make thoughtful, individualized decisions about their care.