Silent Boundaries

In my perfect world, we could learn to set clear and kind boundaries, and share them with the other humans. This helps us to care for ourselves (and maintain compassion for others), and it helps them to know what is ok and what is not ok.

However, there are, unfortunately, many circumstances in our lives where it may not be safe to share boundaries. This could be true for your physical safety at times, but more often it seems to be more about political safety in our work environments. When our work cultures are palpably structured on the sacrifices of physicians and other professionals, for example. When rigid hierarchies dictate that physicians “fall in line,” and follow a particular path, such as in academic medicine, for example. When our work cultures are simply toxic, including malicious gossip and judgment.

I wish that these circumstances didn’t exist. But they do. And many physicians find themselves in these environments, facing political backlash when they try to establish boundaries. 

So what to do?

First, remember that showing up for work each day, at this particular job, is a choice. Although there may be situations that make it hard to leave THIS particular job (academic trajectory, loan forgiveness, etc), when we see it as a choice, it helps to change our perspective.

Next, decide for yourself what is ok and what is not ok. There may be a culture that physicians take walk-in patients for example, and just suck it up. You might decide that you can’t do this, or you can only do it on certain days because of other priorities in your life (childcare, self-preservation, an exercise class, all are legit here). It may NOT be ok for you to announce this boundary to others, but when a patient gets added on, you address it by letting them know that you can’t see them today. Or you tell the front desk, or the person who knocks on the door to “ask” if it’s ok. Simply tell them “no, that won’t work today” and then stop talking. You don’t need to justify or explain.

Finally, normalize the other side of a boundary. For many of us, we are constantly asked to add on more work, without it really being an “ask.” People, including patients, staff and colleagues, often just expect you to roll over, suck it up, etc. So when we do say no, we catch people by surprise. They may be disappointed. They may be upset. This is normal. Especially if they are used to you complying. So let’s normalize here that other people get to have their own responses. AND, their displeasure is not something you have to own. With learning boundaries, learning to say no, learning to stand up for ourselves, we get to trade the feelings of resentment and frustration we carry from always being asked to do more, for the discomfort of upsetting others, disappointing others, etc. If we learn to expect and accept that this can happen, we won’t see other people’s responses as proof that we can’t set boundaries. We’ll simply see it as us adjusting to a new way of doing things, and other people doing the same.

So if this is you, and you don’t feel comfortable speaking up for your boundaries and vocalizing to your boss or your colleagues, it doesn’t mean that you can’t have a boundary for yourself. 

- No walk-ins. 

- You will take 10-15 minutes for yourself in the middle of the day to eat, pee, and take a breath, even if you are late to a meeting or have to leave early. 

- Patient emails are not a substitute for an appointment, so you won’t “just prescribe me a z-pack”.

Whatever it is, practice it. And keep going, even if it feels rough. Time to stop rolling over and donating all of our time and energy to others, and feeling depleted, drained, and frustrated. Longevity in medicine, and wholeness in our personhood requires that we learn to take care of ourselves and to set boundaries so that we can be present in our work, and compassionate with others. 

Boundaries are not selfish. They are vital.