The ask comes from someone you like. Your chair. The partner who covered your shifts when your dad was in the hospital.

“Can you take over resident journal club through June?”

You used last week’s line. You bought a day. Now the day is up.

And the honest answer is you can’t. Not “don’t want to.” Can’t.

The Challenge: you think there are only two answers

Yes and no are the only answers most of us were ever taught. Yes costs you three months. No feels like a wall, and walls feel rude when you’re putting one up in front of someone you respect.

So you go back to yes.

But the person asking doesn’t need you. They need the problem solved. Those are not the same thing.

The Solution: answer the problem, not the request

A counteroffer says no to the request and yes to part of the problem.

“I can’t run it through June. I can run October and November and help you find someone for spring.”

“I can’t join the committee. I can review the draft policy once before it goes out.”

Two rules. It has to be something you will actually deliver. And it needs an end date. “Let me know if I can help” is not a counteroffer. It’s a wall with a window painted on it.

The Prompt

I am a physician. Someone I respect asked me to take this on: [the ask, who asked, and what they’re trying to accomplish]. I can’t do all of it. Here is what my next three months actually look like: [list].

First, tell me what problem they are really trying to solve. It may not be the one they asked about.

Then give me three counteroffers. Each one should solve part of their real problem and have a clear end date. For each, tell me what it costs me in hours and what it gives them.

Then write how I’d say the best one out loud in under thirty seconds. Plain words. No apology spiral.

Do not let me offer more than I can deliver.

The Number: 76 percent vs. 51 percent

​Babcock and colleagues ran experiments, published in the American Economic Review, on a task nobody wanted to do. When asked, women said yes 76 percent of the time. Men said yes 51 percent of the time.

The gap wasn’t about preference. In single-sex groups, it disappeared. It tracked who was expected to say yes. And the people doing the asking went to women more often.

This was a lab, not a hospital. But you’ve watched it happen in your department. The ask goes to whoever is known to say yes. Every full yes makes you the first call next time. A counteroffer changes your reputation without costing you the relationship.

The Move

Take the next reasonable ask that lands on you. Before you answer, write down the problem behind it in one sentence.

If you can’t name it, ask them: “What do you most need out of this?” Their answer usually hands you the counteroffer.

Next Sunday

A counteroffer works on new asks. It does nothing about the yes you gave in a hallway last spring that is still eating your Tuesdays. Next week: how to get out of a commitment you already made without burning the bridge.

Dr. Heath

P.S. Reply and tell me which of the five you are keeping. I read every reply.

I work with physicians on burnout, leadership, and figuring out what comes next. If this newsletter keeps describing your week back to you, that is usually a sign it is worth a conversation. Book a free Clarity Session.​

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