Nobody's Coming to Save You — So Here's What to Do Instead

I had a breakfast meeting with one of our fellows the other day. (Meetings = generally bad. Breakfast meeting = always good.) She was telling me about a completely ridiculous situation currently playing out with her research project. She submitted her research proposal to our informatics group, outlining what she'd need from our EMR to answer her research question. Said group gave her a quote for the funding they'd need to pull that info out of our EMR for her. Easy, right?

Later, said group wrote back, saying they hadn't read her submission completely. They'd only read the first page of the three she'd submitted. They would not be able to do what they'd agreed to for the quote they'd originally sent her. They would need significantly more funds. This was the group-sanctioned paperwork that our fellow filled out, by the way. She did exactly what they asked. They only read a third of it, gave her a quote, and are now coming back to say they need more funding to do what she thought was done, settled, and checked off her list. (There is no more funding to be had, BTW, because she used the original quote in the math that she used to get her project's funding.)

W. T. F.

I was livid — LIVID — when she told me this story. I haven't caught up with her research mentor to hear what she thinks of the situation yet. Our fellow had had a few days since this email exchange, so she was able to stay pretty calm when she told me what was going on. But let's be honest, I was probably livid enough for both of us. And her research mentor. And her fellowship directors, now that I think about it.

When's the last time you got screwed over, through no fault of your own? And I mean (let's be really honest with ourselves here) literally no fault of your own? When I think of my own situations, getting put at a disadvantage truly through no fault of my own is pretty rare. There's almost always something I could have done differently: over-communicated, asked more questions, been a bit less laissez-faire about whatever I was going through. I can even give myself grace when I've been screwed over because I didn't know what I didn't know. That's just bad luck. But when you've done exactly what was asked of you, and somebody who should know better makes a mistake that puts you squarely on your back foot, what do you do?

Do you rage? Outwardly or inwardly? Get real quiet, shutting down because you just want the whole thing to be over with? Or get real quiet because you're plotting your revenge? Or are you highly evolved: able to get super focused, collect all of your best strategizing thoughts immediately, communicating with the "attract more bees with honey than vinegar" tone that makes the person who screwed up think it's their idea to fix the problem they created? I can do any or all of those, and it totally depends on all sorts of external factors that usually have nothing to do with the issue at hand.

Our fellow was not in a position to be highly evolved. In the huge, clunky systems of academic medicine, learners can be put at a disadvantage (they can quickly become afterthoughts within divisions that are disconnected from them). She'd already started trying to fix the situation herself, because she's a go-getter; she wasn't just going to complain to her research mentor and depend on her to fix it. Her fix? She's cutting things from her project. She's trying to fit her round peg into the square hole that the informatics group has created for her.

When she told me this, I replied with "ABSOLUTELY. NOT." Apparently, I was outwardly rage-y the day we met.

This, I told her, was a golden opportunity to learn the skills of negotiation and self-advocacy.

The Part Where We Talk About Women Advocating for Themselves

In general, women feel they don't advocate for themselves well. Women physicians don't feel much better about the skill. We are socialized to think of others before ourselves, to go-along-to-get-along. Let's just call a spade a spade and get this part over with: we learn, very young, that men who advocate for themselves are strong and committed, and women who advocate for themselves are difficult at best and bitches at worst.

The original Aunt Vivian on The Fresh Prince of Bel-Air — actress Janet Hubert — was replaced after she advocated for herself on set while pregnant and trying to sort out a complicated home life. Will Smith, a producer on the show at the time, marginalized her on the set and labeled her "difficult" in the media. "Difficult" is a problematic adjective for all women, but doubly so for a Black woman. She was blacklisted from Hollywood and, while she eventually went on to have a prolific career, always wondered what would have happened had she not had to leave The Fresh Prince. (Yes, I'm showing my age. Whatevs at this point.)

Here's the thing with my fellow: first, she's 100% in the right. And second, she has nothing to lose and everything to gain, because her professional goals don't align with staying at our institution after she graduates. She does not have to play nice in the sandbox. She doesn't have to maintain any sort of relationship with the informatics group beyond the next year and a half that she's working on this one project. And finding an opportunity to learn a skill in a lower-stakes environment is golden — especially when, like a fellow in academic medicine, you've got a job search coming up, a situation in which negotiation and self-advocacy can have high-risk, high-reward stakes.

How to Actually Advocate for Yourself When You've Been Wronged

1. Get your emotions out of your system first.

Yell, scream, huss and fuss, rage-journal. The emotions you feel are genuinely important data that your body is trying to communicate to you, and you'll only get the benefit from them if you really understand where they're coming from. Plus, if you don't process the unhelpful emotions first, they'll come out as drama when you're actually negotiating. Nothing derails a legitimate grievance faster than presenting it while you're still in the thick of the feelings. Give yourself a time limit on the venting, but don't skip it.

2. Find the math of the situation, not the drama.

Figure out what the stakes actually are, as neutrally as possible. Whining, "It's not fair," is ineffective. "This is a business agreement, and we need to figure out how you'll be able to meet the obligations you agreed to" is much more likely to get a positive response. Strip out the emotional language. Find the facts. What did they agree to? What did you do? What is the documented gap? When you present the situation as a business problem rather than a personal grievance, you take power back, and you're much harder to dismiss.

3. Know how important the relationship is (and to whom).

This is where a lot of women physicians get stuck. We overweight relationship preservation to the point that we accept genuinely unacceptable outcomes to avoid any friction whatsoever. Before you go in, get clear: How important is this relationship, really, and over what time horizon? Is the relationship symmetrical; do they need it as much as you do? My fellow didn't need a long-term relationship with the informatics group at all. That knowledge was liberating. If you do need the relationship long-term, that doesn't mean you don't advocate; it just means you calibrate your tone accordingly.

4. Know your best case, acceptable case, and hard stop.

Figure out your "best case scenario," "acceptable scenario," and the threshold below which is unacceptable. If your best-case scenario is your only acceptable scenario, okay, just know the amount of work you'll have to put in and the data you'll have to present to make it a reality. Going into any negotiation without knowing your floor means you risk agreeing to something you'll resent later. And resentment is corrosive. Know your number before you walk into the room.

5. Put it in writing before you open your mouth.

Before you send a single email or walk into a single conversation, draft your position on paper. Not to send, just to think. Writing forces clarity in a way that rumination doesn't. What happened? What was agreed to? What documentation do you have? What are you asking for? When you have to articulate your argument in writing first, you discover the places where it's fuzzy, the places where you're still operating from emotion rather than evidence, and the places where you're actually rock solid. The written version becomes your compass for the conversation.

6. Use the broken record…strategically.

There's a technique in assertiveness training called the broken record, and it works. You identify your core ask, and you return to it calmly and consistently, no matter what tangents, deflections, or justifications the other party introduces. "I understand there was an internal miscommunication on your end. What I need is for the original scope of work to be completed at the originally agreed-upon price." Then they say something. Then you say it again, slightly different words. You are not arguing. You are not escalating. You are just not going away. For women who have been socialized to drop it and accommodate, this feels wildly uncomfortable at first. Do it anyway.

7. Stop apologizing for the problem they created.

Women are particularly prone to over-apologizing; it's practically a reflex. Watch for phrases like "I'm sorry, I just want to make sure I understand" or "I don't want to be a problem, but..." before you state a completely legitimate position. You don't need to soften the fact that someone else made an error that affected you. You can be warm, professional, and completely unapologetic about what you're asking for. "I appreciate you getting back to me," is warm. "I apologize for any confusion," when you created zero confusion is giving away power you don't need to give away.

8. Bring your documentation, always.

This is academic medicine. Everything has a paper trail, or it should. Before any high-stakes conversation about a situation like this, assemble your receipts. The original submission. The original quote. The follow-up email. The timeline. You are not coming in hot. You are coming in organized. There is a profound difference. When you can say, "On this date, I submitted this document, and on this date, you confirmed this scope at this price," you're not making an argument. You're presenting facts. Facts are harder to gaslight than feelings.

9. Know who your allies are — and activate them appropriately.

Self-advocacy doesn't mean going it alone. It means knowing when and how to bring in reinforcements. In my fellow's case, her research mentor and fellowship directors exist precisely for situations like this one. Looping them in isn't weakness, it's working the system correctly. The key is to loop them in as informed allies, not as saviors. "Here's the situation, here's what I've done so far, here's what I'm asking for, and here's where I might need your support" is a completely different posture than "I have no idea what to do, please fix this." The first version makes you look competent. The second one, though sometimes true, doesn't serve you.

10. Debrief yourself after.

Whether it goes the way you want or not, take fifteen minutes afterward to ask yourself: What worked? What would I do differently? Where did I feel myself shrink? Where did I hold my ground? Self-advocacy is a skill, and skills are built through deliberate practice and honest reflection, not just repetition. The fellow who handles this situation today is building the toolkit she'll use in her job negotiation in eighteen months. And that one matters.

The Bottom Line

My fellow is going to be okay. She's already the kind of person who tries to solve her own problems before she asks for help — that instinct is good. She just needed permission to redirect that energy from "how do I make myself smaller to fit this problem" to "how do I make this problem fit what I actually need."

That permission? Consider this it.

You are not being difficult when you hold someone to what they agreed to. You are not being aggressive when you present documented facts and ask for a reasonable outcome. You are not being a problem when you refuse to cut your research project in half because someone else only read a third of your paperwork.

You are advocating for yourself. And unlike a lot of things in medicine, this is a skill you can practice (with lower stakes!) before the high-stakes moment arrives.

Find your breakfast meeting. Find your ABSOLUTELY NOT. And then get to advocating.