Doctors without (Personal) Borders

11/30/2018 10:56 AM | Anonymous

I know some doctors who have never learned to establish good boundaries in their lives. By that I mean, they really don't know how to say "no." This is not entirely their fault: the medical education process teaches not only the applied practice of medicine but also the fortitude to be able to go beyond what is comfortable. And that involves a lot of boundary violations.

So, it is no surprise that after residency, many physicians never really learn how to take back control of their life and save some white space for themselves. It can be a mental, and even spiritual, exercise to work through the difference of "the patient always comes first" and the need for your own rest, rejuvenation, and personal life away from medicine.

Here are a few thoughts on creating some healthy borders in your life for your own longevity's sake:

1. Give yourself permission to set boundaries. The practice of medicine will consume every inch of ground in your life that you don't reserve for other purposes.  It does not help that your education and enculturation will tell you that is normal. But it is your right to decide how much you’re going to give. You must choose when you are going to be generous, otherwise, it is too easy to feel resentful for giving more than you wanted to.

2. Know your values. It is crucial for you to know in your life what is inviolable except under the most extreme circumstances. Is it your running therapy? Weekend worship? Family vacations? Personal space? Only you can say what you need to protect and what you can afford to be squishy on.

3. Create structure.  Sloppy boundaries invite incursion. I remember a time when my wife was pregnant before we had a fence built and the neighbor boy would practice his ball bouncing skills against the outside wall of our bedroom. Not only did we tell him not to do this, eventually we built a fence. Structure in your work and family life helps reinforce boundaries you have established.

4. Communicate your limits clearly and proactively. The Great Wall of China was a pretty effective sign saying, "thus far and no more." Same thing with razor-topped fences around U.S. military facilities. If you have not yet communicated to others what your boundaries are, then you cannot assume they are going to respect them.

5. Prepare for violations. You can bet that every civilized nation has a plan for what happens if their neighbor crosses into their territory, be it land, air or sea space. People will push your limits, intentionally or otherwise, and you need to become adept as a physician at how you will respond. It does not have to be harsh, rude, or violent – it just needs to be clear and firm.

6. Pay attention to your feelings. Guilt, resentment, anger, lashing out at others: these are all red flags that something has been violated, sometimes unspoken or unarticulated even to yourself. What kind of warning signs tell you when somebody has crossed a perimeter that you have established?

7. Bring up boundary violations quickly. It is not effective to tell somebody that they violated your boundary six months ago. A perfectly acceptable response in the moment –  and an example of training others what your limits are – might sound like, "No, I am sorry.  I will not call in that prescription because I am not the doctor on call. Please call Dr. Jones instead." The problem with saying, "just this once" is that it never seems to end that way.

8. Practice saying "no." It is so difficult for most of us to feel like we are letting others down and there are certainly times in your calling when you will have to say "yes" even though you don't want to. That is fine and none of us get this perfect. This is more reason why you must practice saying "no" to things you really can deny.

​When doctors unlearn some of the "brainwashing" they underwent early on, it helps create a more sustainable life of service to others.

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