“No, thank you.”

Learning those three words can do wonders for people’s mental and physical health. Many of us have a friend who literally dropped dead of exhaustion. Or the relative who had a stroke during a business meeting. Or the acquaintance who had a heart attack in the middle of the night and never woke up. The list goes on, and many of these fatal or near-fatal incidents may be preventable if there were just a little less stress in that person’s life.

As a doctor, I’ve been overworked for pretty much my entire adult life. Starting with medical school, sleep has always been at a premium, and there never seems to be enough of it. Some classmates couldn’t stand it and either quit or gave up clinical work entirely after graduation. Not me, I went back for more.

In an internal medicine residency in the US, we worked 80 hours a week with on-call 24-hour duties every five days. This was considered light compared to the brutal 24-plus-hour duties every three days at home.

This willingness to accept inhumane work hours has haunted my generation (Gen X) and more than a few millennials who were convinced that this was a good idea by their Gen X parents. Taking on more work used to be seen as a badge of honor, and saying no was considered a weakness. “Suck it up,” was the common refrain from our seniors. If they survived it, then we could, too.

In addition, culturally, most Filipinos are people pleasers who are loath to say no to anything. Consequently, there have been a good number of us who are dropping dead in their 40s and 50s, along with a fair number of strokes and heart attacks.

I learned to say “no” early in my career as a matter of survival. When I joined the University of the Philippines as faculty, I was expected to teach students, do research, and see patients. For a couple of years, my clinic schedule wasn’t so busy, and so I was able to handle everything with minimal problems.

But then my clinic load started picking up, and I was given more and more administrative responsibilities. Suddenly, there weren’t enough hours in the day, and I was getting less and less sleep. I figured that if I didn’t put any boundaries given my generally unhealthy lifestyle, I would end up disabled or dead. And I had two young children, so this wasn’t an option. It was a good thing I realized it early. Some of my colleagues, including some who are younger than me, haven’t been so lucky.

So, is there a way to say no gracefully? How can you let people know that you aren’t willing or able to do something for them without offending them? Although my experience hasn’t been perfect, these tips have been effective for me.

There are some things you can say no to, but there are things that aren’t negotiable. Core functions of your job for which you are paid a salary cannot be refused; otherwise could get fired. I have to show up at executive committee meetings, strategic planning workshops, and required seminars without fail. However, many activities can be easily skipped without dire consequences, such as webinars, optional outings, and numerous parties. If you can’t say no, accept the task graciously so you get full credit. If you complain and you have to do it anyway, you’ll be seen as difficult and uncooperative.

Some people make up stuff like a schedule conflict as a means of saying no and get caught red-handed when they forget their little white lie. If you are exhausted or simply want a break and do not want to accept an invitation, say so. In this day and age, mental health breaks are acceptable reasons for not doing something. Older people like us just have to get with the program. A simple “no, thank you,” without further explanation, is completely acceptable.

If you want to offer a reason, be honest. Say that you have too much on your plate and you need to prioritize other things. If it is an additional task that needs to be done, just say that you feel you wouldn’t be able to do a good job if you had to do this on top of everything else you are doing. Whether or not people appreciate your honesty is not something you can control. However, if you turn in substandard work or delay the rest of the team because you said yes, even if you were overloaded, then you’d be in hot water anyway. Not only will you end up having done extra work, but people will also get mad at you for delaying and/or degrading their output.

Taking on administrative work like becoming the director of my institute, which is work that I like, insulates me from being asked to do a lot of things I don’t like. Ad hoc committee work can easily pile up, but because I have a full administrative workload, I can easily beg off and say my plate is full. If you are intentional about taking on the things you like doing when they are available, you can avoid the things you don’t want to do.

If your job is much too burdensome and you are starting to feel sick because of lack of sleep and too much stress, then you may need to find something else. Not everyone will have the luxury of shifting jobs or walking away, but if you have that option, you may need to take it. If you end up dead or disabled, then you won’t have a job anyway. If you can’t afford to walk away, discuss a lighter workload with your boss and take some time off if available. Nothing is worth sacrificing your long-term health, and a reasonable boss may be willing to compromise rather than lose your entire output.

These are just a few techniques I've learned through years of personal and professional experience. Every industry has its own challenges, but the purpose of this list is to remind people that knowing when to say no is essential for maintaining both health and productivity. As Filipinos, we are sometimes reluctant to stand up for ourselves, but preserving our health is the one thing we should prioritize above all else.