Setting boundaries as a fully fledged physician is a surprisingly difficult mental hurdle for many of us. Medical training requires 12-20 years of going above and beyond, saying yes to everything, people-pleasing, and jumping through hoops. We compromise our sleep, our health, and our relationships in order to get to and complete each new step. It starts in high school and continues beyond residency and fellowship. Once we are in our first jobs after training, we are working to build trust with our colleagues, build a patient base, become a partner, or be promoted. This requires us to continue to say yes to everything.
And then one day we find ourselves several years into a stable position on the brink of burnout. At that point many of us start to ask ourselves, wait, can I say no to things? How can I make this job/career sustainable? Not only CAN you start to set boundaries, you MUST in order to maintain your mental health and to have longevity in this career. It is now up to you to engineer your life in a way that allows you to start to enjoy it. This means re-evaluating every aspect of your job. How many days per week do you want to work? How many patients do you want to see? What setting or system do you want to see patients in? Do you want to take insurance? Do you want to do administrative work? Do you want to do research? Do you want to start earlier, and take an hour off in the middle of the day? It can be really difficult to see that all of these are options when for a couple decades we have been doing anything people suggested while holding our bladders and eating crackers with peanut butter in hospital hallways.
Remember - Its ALL optional. All of it. You can say no. You can choose differently. You can make this career work for you.
In the book Set Boundaries, Find Peace, the author Nedra Glover Tawwab says:
"Burnout is a response to unhealthy boundaries... Burnout is caused by:
Not knowing when to say no
Not knowing how to say no
Prioritizing others over yourself
People-pleasing
Superhero syndrome ("I can do it all")
Unrealistic expectations
Not being appreciated for what you do"
I don't know a single doctor that the above wouldn't apply to, and who wouldn't benefit from learning how to set appropriate boundaries.
A couple big revelations came up for me while reading this book. The author states people can ask you anything they want. It is up to you to say no and set limits. I don't think I'm alone in my past experiences of being bewildered/annoyed/angry by someone even daring to ask me to do more. My thoughts and words to people other than the one making the request would be something like "Who does that?? Can you even believe they would ask that?" Well guess what? They can and they do. It is up to me to say no and stay firm in my goals, values, and boundaries. Similarly, adult humans can act however they want. It is up to each of us to be the gatekeeper for what we allow in. This means re-directing a patient's conversation, referring a patient to someone else, stepping out of a gossip zone, logging out of social media, turning off the news, closing your door, or excusing yourself from a conversation to get your work done.
The second revelation was there is no such thing as setting a guilt-free boundary. Many of us avoid saying no or setting boundaries because we fear we will feel guilt, remorse or sadness when it comes to disappointing others. The author states very clearly that we WILL feel those things but to set them anyways. Accept and process the short-term discomfort of negative emotions in order to reap the longterm benefits of less tension and more time.
It can be easy to look at the specifics of your overwhelming job or schedule and start to blame the circumstances. "My partners/administrators are placing unreasonable expectations. My co-workers won't let me get my work done. My patients are high maintenance. The medical system is broken." It is very tempting to look for a fix in a new job or career. But if you have not learned how or ever been brave enough to set boundaries, you will very likely fall into a similar situation in a new job or career. The people and office will look different, but the quick slide to overwhelm will be exactly the same.
For so many years we have allowed others to have all of our time and energy, and we have outsourced our schedules, our power, and even our own value. We have been told who we were based on grades, scores, publications, number of patients seen, speed of surgeries, and revenue generated. Its time for each of us to define our own value. To take back control of our time, our energy, our desires, and our definition of what a fulfilling career in medicine might look like.
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