Advancements in technology have blurred the lines between work and home life. This is because modern technology, such as the smartphone has made it easier for others to reach us. Time and location no longer serve as barriers. It is not uncommon for work-related matters to reach us via email or text after hours. People are continuing their work from home rather than enjoying precious time with loved ones.

Physicians are familiar with this changing landscape. Increased productivity and documentation requirements, endless requests for prior authorizations, and compliance with evolving quality measures have placed higher pressure on physicians. It should come as no surprise that more than 40 percent of physicians are burned out or depressed.

The antidote to this state of affairs is firm boundary setting. Boundaries are an emotional fence between you and others. The fence contains a gate. This gate is sacred and one of the few things that you can control.

Think about how little control we have. As physicians, we are aware that we do not even have full control over our own bodies. Our organs function on their own without our input. Our immune system fights off invaders without our volition. We succumb to illness without our choosing. If we have such little control over our own bodies, you can imagine how little control we have over other people. We cannot prevent others from asking us to assume additional responsibilities. The lack of control can lead to feelings of helplessness and anxiety.

However, there is one thing that you can control: the gate on the fence. This is your responsibility and of utmost importance. It is the path to setting healthy boundaries and regaining control in your life.

You open the gate by saying yes to others’ requests and taking on additional responsibilities. The gate cannot stay open indefinitely. Otherwise, you will be swamped with obligations. If you never close this gate, you will find yourself spread too thin and overwhelmed.

Therefore, you need to say, “no.” This can be difficult. Feelings of guilt and obligation can interfere with our ability to say no. Exploring such feelings is imperative for healthy boundary setting.

Guilt arises from the difference between your behavior and what you expect of yourself. It is the feeling that you are doing something wrong by failing to meet expectations. There are only two ways to reduce feelings of guilt. You may increase your level of activity to match your expectations or lower your expectations to the level of your behavior.

There is a problem that arises when you constantly increase your level of activity to cope with guilt. You are compromising your wellness. Levels of anxiety increase as you are spreading yourself thin to meet increasing demands.  You experience feelings of resentment because you assume additional responsibilities out of obligation rather than sincere desire. Not to mention, you are conditioning others to request more out of you. This is learned behavior. Look at it from their point of view. If you always accept someone’s requests, why would they not continue to approach you with additional requests?

Therefore, the answer to coping with feelings of guilt and obligation is lowering your expectations to more realistic and sustainable levels. Lowering the bar to such levels is not an invitation to complacency. Rather, it is a tool to help you cope. Subsequently, saying no becomes more feasible.

Boundary setting has been pivotal in helping me find a balance in my personal and professional life. For example, I do not fulfill any clinical duties on the weekends. That time is devoted to my family and church. I cherish spending that time with loved ones and serving at my parish. This time is non-negotiable and will not be compromised. There have been plenty of requests to round on the weekends which I have politely declined.

Please be aware that you have no control over how someone responds to you saying no. People may become upset when you set boundaries, which could even lead to conflict. Recognize that you are not responsible for their emotional reaction. If someone becomes upset when you set a boundary, then it is their responsibility to regulate their emotions and respond in a mature way.

Also, embrace your identity as a physician. You are in demand! You have options! You are not trapped. Pursuing such options can be scary. Perhaps they are not ideal or convenient. However, they do exist. Explore them. Speak to a physician recruiter to gather data on job prospects. You did not sacrifice over a decade of your life and accumulate significant financial debt to become a physician, only to relinquish control of your life to an outside party. Saying no is your responsibility. Nobody else will do it for you.

Saying no is not a selfish act. It is an act of self-preservation. Being selfish is defined as caring only about your own wishes and desires while completely ignoring those of others. Engaging in self-preservation involves taking steps to promote your wellness, which is necessary to continue meeting your responsibilities and serving others at the highest level. Setting healthy boundaries will help you be a better physician, spouse, and parent.

I want to leave you with a final lesson that I share with my patients. Saying no is unavoidable. If you do not find the courage to say no to others, then you will be saying no to your freedom and peace of mind. You get to pick the recipient of your no!

Dimitrios Tsatiris is a psychiatrist and can be reached on Twitter @DrDimitriosMD.

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