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Join emergency physician Shideh Shafie as we delve into the crucial topic of setting boundaries in the medical profession. Shafie shares her personal experiences navigating the delicate balance between personal and professional life, discussing the impact of cultural expectations, strategies for effective communication, and the positive outcomes of boundary enforcement. Discover practical tips and techniques for health care professionals striving to maintain their well-being while serving their patients and communities.

Shideh Shafie is an emergency physician.

She discusses the KevinMD article, “Physician work-life balance: How boundaries protect you and your patients.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast, get CME for this episode by clicking on the CME link in the show notes. Today we welcome Shideh Shafie. She’s an emergency physician. Today’s KevinMD article is “Physician work-life balance: How boundaries protect you and your patients.” Shideh, welcome to the show.

Shideh Shafie: Thank you, thanks for having me.

Kevin Pho: So let’s start by briefly sharing your story and journey.

Shideh Shafie: So I’m an emergency room physician. I actually started off in urology but switched over mid-residency, realized that I like talking to my patients more than operating on them. And I am also a coach.

During COVID, when people were really suffering, I sort of decided that people needed help. And I had been through coaching after having a horrible head trauma, where I learned about neuroplasticity, mindset work, body work, all this stuff. I had this horrible trauma and thought that I had epidurals, subdurals, pneumocephalus, all the bad things, and I not only survived it, but I actually used that as a huge impetus to be really conscious about how I want to structure my life.

And I actually did a certification in 2010 at that point, but I was a young physician who was killing it in the ER and in admin and all that kind of stuff, and I said, I’m going to come back to this as a retirement career at some point. And then COVID hit, and Rhode Island did pretty poorly during COVID, and I was like, oh, people need this help now. So I just created programming around it, and then that sort of led into doing this, physician work part time and coaching part time, and I love it.

Kevin Pho: All right, so tell me about some of the coaching clients that you see. What are the common issues and problems that they come to you for?

Shideh Shafie: So I coach high performers across industries, so I don’t just coach physicians, I coach people in tech and finance and in different spaces. And one of the things that’s hard is, a lot of what made people really successful, they’re successful, everybody has enough money, everybody has high, awesome careers, but they’re not enjoying their lives, and they also want more, and they feel bad for wanting more, and they don’t know how to take on more. And so we kind of sort all of that out.

There’s nothing wrong about, like, life is this big game and it’s super fun, and it’s fun to win, it’s really fun to win, but to win you have to take some bad shots too. So I love helping people understand that stress is part of life, especially if you have massive big goals, but learning how to move through that stress in a way that makes it enjoyable and fun, and go through it with lightness but also with power. Light and power are kind of the two things you really need to enjoy this life that we’re building. So yeah, that’s what I do.

Kevin Pho: Now, you see people, like you said, across industries. Are there commonalities that affect both physicians and non-physicians that you’re seeing in your coaching clinic?

Shideh Shafie: 100 percent. One thing I see that’s really common is feeling guilty about what you want in your life. No, it’s fine to want things in your life. Also, not being able to turn off your brain. So you’re creating these amazing lives, and then when you’re on vacation you’re still thinking about, oh, my business, or you’re sitting down and having dinner with your spouse or with your kids and you can’t turn it off. They don’t sleep well, right, because their brain is churning. And that’s just a habit that you have developed, that habit of sort of feeling like everything has to bleed together.

And that sort of is one part of boundaries, are these internal boundaries we have to learn how to set ourselves about how to turn off your brain when you’re just here to have fun, or to play. For me, one of the best practices, and I’m an ER doctor, right, I’m not really into yoga, it’s kind of boring to me, I can’t turn off my brain there. But in tennis my brain shuts off, because all I’m thinking is, how can I get this next point, how can I hustle to the ball, get up to the net and crush the other player? Which is this very narrow exercise in mindfulness, where all I’m focused on is that ball and how my body can get there. And it’s a good practice for learning how to turn off your brain and be in the moment with whatever that goal is, because it’s not useful to continue to ruminate.

And I’ll tell you, I’m in the middle of a big real estate deal right now, and there’s a lot of pieces that I have to still sort out, but it’s not useful if I come to this session where we’re recording together and I’m just thinking about the real estate in my head and I don’t bring energy to this space. So learning how to separate that and really put all your energy and focus into the goal that’s at hand.

And we already know how to do that as physicians, by the way. It’s just learning to apply it in the system, right? I’m an emergency room doctor. I know that I have six other patients, but if someone’s coding, all my energy needs to be in this room. Or if I’m putting a central line in, I can’t be thinking about, room three has appendicitis, you can’t do that. So you already know how to do that, you just have to learn how to apply it in these other spaces. And it’s a superpower, because it allows you to really grow what it is that you’re trying to grow in that moment, and to find solutions quickly as opposed to exhaust yourself looking for solutions. So boundaries, I think, are hugely important, both externally and internally.

Kevin Pho: All right, and you talk more about that in your KevinMD article, “Physician work-life balance: How boundaries protect you and your patients.” Now, for those who didn’t get a chance to read that article, and I know you led into this, tell us more about it.

Shideh Shafie: It starts off with my dad, who I adore. My parents are lovely, and they’re first generation immigrants, and sometimes in first generation immigrant communities, it’s like they’ve taken care of each other forever.

And so my parents call me from a party, and he says, Shideh, I really need you to talk to this lady, she has a medical emergency. And I’m like, what? I’m in the middle of taking care of my twins, it’s my weekend off with my husband and the kids. And it’s this lady who drove from Pennsylvania to Massachusetts, and her kid had some kind of viral syndrome. The doctor told her that the kid needs rest and to stay at home. She decides to drive to a party instead, several hours, to go to this party, and her kid has a fever and she’s worried.

And, yes, do I want to help people in the world? Yes. But can I spend my whole time? That’s my time off. I’m not her doctor, I don’t have a relationship with her, I don’t love her decision making. And my dad’s like, can you just help her? And I do help her, right. But then I call my parents and I’m like, you guys can’t do that, you can’t introduce relationships like that, that’s not my role. I can’t be a doctor to every single person all the time, that actually doesn’t work for me.

And they’re like, well, you’re interrupting this party. And I was like, well, you interrupted my weekend. And it feels really bad to say that to your parents, who, I have a lot of deference for my parents, they left Iran and made an amazing living for us here, which takes a lot of sacrifice and hardship.

But also, this is the thing about boundaries. Some boundaries, you can tell people, and with my parents, I’m close to them, I can tell them, I don’t want you to call me with other people’s medical problems. And if I don’t tell them that, then it’s going to create resentment, like, oh, here’s my parents calling me again for this. I don’t want to create resentment towards my parents. I want to love my parents. And so boundaries are a way to protect us from growing resentment towards the system.

Now, if this is a random person that calls me, random because, you know, if you’re an emergency room doctor there are these people who have no internal boundaries and they just call you all the time or send you texts about their medical problems. I don’t want to be in relationship with you as your doctor, because you’re my random person that I know from the neighborhood. And so there you have to decide, do you want to say that out loud, because there’s an awkwardness, or do you just wait it out and just don’t answer them, or do you say something in between, like, hey, I actually don’t know, you have to go figure it out? You get to decide how you’re going to do it. But otherwise you’re just allowing people in these relationships and then you get annoyed every time they text at you, and you grow resentful of them because you’re not willing to say to them, I don’t want to be in this relationship with you in this way.

And it’s really important, and also internally, as doctors, our identity is so tied into being a doctor, so even sometimes we can feel the need to serve as a doctor even when no one’s even asked us. I’m on a parent group chat, and somebody asked something about their kid, they had gone to the ER and they didn’t like the experience and whatever, and I felt this need to come in and be like, well, you should do this and consider this and blah blah blah. And then I was like, oh wait, I don’t want to be in relationship with these people in this way, I don’t want to open myself up to that kind of relationship with this entire, you know, 40 parents in this group. And so internally we have to learn to protect our energy, because our energy, it can’t all be towards work, it’s got to go to the other spaces in our life where we want to grow.

Kevin Pho: Talk about boundaries in a professional setting. I talk to a lot of physicians, maybe not necessarily emergency physicians but in primary care, and administration always asks them to see more patients, be on some committees, do more paperwork. Talk about boundaries in a professional setting, and how sometimes a lack of boundaries can lead physicians to take on too much and burn out.

Shideh Shafie: Yeah, I mean, I actually recently coached someone on this specific topic, a physician proceduralist who is in an RVU based setting owned by VC, so RVU pay. So basically this person decided to cut their hours, that instead of going five days a week full time, they wanted to, in the mornings on one day of the week, not go in, because they were having some health issues that they wanted to get sorted out. And of course, when they decided to do this, after a few months they get called into the office to be talked to by admin, like, you know, you’re making less money. It’s like, yeah, 100 percent, that’s the role we play sometimes.

So, first, recognizing the roles we all play. We are in charge of our own boundaries and our own energy and our own time and our own health, and the job of the admin is to suck out as much juice out of your lemon that they can. You get to decide how much of it you want to give to them. So of course they’re going to be disappointed, because how do they make their money? They make it on skimming off the top from yours. And that’s OK. But there’s a ratio at which that becomes not profitable for them, the return on investment of having you employed doesn’t make sense. Like Tuesday mornings every week off might be OK, right?

So understanding, first of all, that their job is not to protect you and your energy, their job is to extract value from you, to pay for the hospital, to pay for whatever else they need to pay for. And we don’t have to get angry about that, those are just the facts of the situation. Because when we look at it from that, then we realize, oh, it’s not their responsibility to do that for me.

And the same comes with when we think about, see more patients. Actually your duty is to the patients, and your duty is also to make sure that you are able to deliver safe, high quality care to these patients. And their duty is to try to whip you as hard as they can to get more money out of you. That’s their duty. Their duty is the fiscal responsibility of the institution that they serve. And so when you see it from that standpoint, you can, like, oh, of course that’s what they’re going to do, and I just have to ride up to the line of, that’s unsafe, I can’t do that.

And at some point, it’s uncomfortable, right? The thing that’s hard with boundaries is that it’s not saying them out loud that’s hard. You can say, like, don’t call me after 8 o’clock, that’s easy to say out loud. The hard part about boundaries is when someone does that, what are you going to do? How do you respond? You don’t pick up your phone. That’s what it looks like to say, I’m not available after 8:00 p.m. And if someone calls, you don’t respond. If they text, you don’t respond. And that part feels awkward for us, right?

And it’s really, we are raised in this house of medicine, that especially as medical students, your whole life is medicine, same with residency, your whole life is whatever residency you’re doing. And then getting really aware of the language that gets utilized, especially, I’m from academia, like, we’re a family. No, we’re not. We’re actually not a family, right? Because family has reciprocity. What I do for my parents, what I do for my husband, what I do for my children, what I do for my in-laws, they also will do for me.

But there’s this concept, especially in academia, that, oh, we’re a family, and so, we’re understaffed because we didn’t have great hiring practices, can you take on a ton of overtime? But when you go on maternity leave they don’t give you extra time off, because they’re your family. They don’t send you casseroles every week, right? They might send you one flower basket, because that’s what every department does. But family is an exchange. This is a business relationship, and it’s different.

And so when we look at it from that standpoint, and look at it as the facts and not get sort of wrapped up in it. And it’s also, we’re in a transition right now in medicine. Physicians used to be owners of their practices, and it’s really different to be an owner, because you’re willing to do different things because you actually own all of it. But when you’re an employee, I think sometimes right now, in the transition that we’re in in medicine, they want owner behavior from employees. And you can’t have it both ways. Either you share in the profits and we’re all owners, or I’m an employee, and then this is your job and you handle the staffing shortages, this, that. And you just have to sort of really come to the facts of that. And I think sometimes we ourselves internalize, like, but I owe it, I owe it. And I think you have to sort of start pushing back on those thoughts and see, who are they serving?

Kevin Pho: Yeah, so easier said than done, right? So like you said, physicians groomed in the house of medicine throughout training, and to get into medical school they always have to devote and sacrifice their life to medicine. So give us some practical tips. How can physicians set those boundaries, how can physicians embrace sometimes that uncomfortable situation that boundaries set? What are some ways that we can do that?

Shideh Shafie: I mean, the first thing is identifying what you need. And the way I really teach boundaries is, they’re sort of there to preserve you. It’s not about pushing people out, because that’s a lot of not great energy, but what do I need to protect myself?

So for me, some of the boundaries I’ve set in my work life is, Fridays after 6 o’clock I don’t answer the phone. Because Fridays 6 p.m. till Saturday morning, that’s family time. I really need that time to recharge and feel connected to my family, because I’m always hustling and doing all kinds of things. So first is identify what a need is, so that’s a simple need.

Then decide on your communication. Are you going to communicate that, who are you going to communicate that to, and does it need to be communicated? So one of the boundaries I have is, if I have two late shifts, you don’t get any more nights from me. You don’t get any more dinners away from my family from me. I don’t need to communicate that to anybody. So when you ask me to come to journal club and I’ve already worked two three to 11s, I’m not coming, and that’s not a boundary that needs to be communicated. But in my business relationships I do need to let people know that after 6 p.m. on Fridays, 6 p.m. till Saturday morning, not available, because that’s an important thing for people to know.

And so, know that, then get ready to enforce. Now, this is the part that’s hard. Prepare for enforcement means, when someone’s trying to guilt you, like, we really want you to come to journal club, you just say no, even though it’s uncomfortable for you. Or when someone’s texting you, but I really need this thing at 7 o’clock tonight, please, you also have to say no. It feels uncomfortable to say no, that’s never going to feel comfortable, but it’s a practice.

And to help me with that, actually with the 6 p.m. thing, I actually put my phone upstairs and I hang out downstairs with my family, so I create a physical boundary just to make it a little bit easier.

And you can understand that it takes practice, right? Sometimes you’re going to mess up and you’re going to let a phone call in at 7 p.m., or you’re going to, like, you know what, this is my best friend from residency, she’s going to be at grand rounds, it’s one night. And maybe that’s not even a mess up, because you want to see your best friend from residency and go to grand rounds in the evening, or whatever. So you get to decide, but you allow yourself, they’re not supposed to be perfect. It’s a practice. It’s like lifting weights, you lift heavier ones each time, and then you make more and more as you need.

And also, be gentle with yourself, that boundaries can shift. Our boundaries look different. I had no boundaries with work when I worked in New York for a long time. My husband and I were there without kids, he’s in law, he’s in big law, so he was working, I was working all the time, it was awesome, we made a ton of money, we had no kids, and we went out to dinner at 9:00 p.m. at night, who cares, you call me whenever you want, I could text you. But now my life looks really different. I have two young kids, I have twins, they’re 8 years old, I have all these other competing interests, and so yeah, my boundaries are going to be different.

And if I was ill, if I had some kind of terminal illness or some kind of thing, it would look different. And you get to shift boundaries based on where you are at life. I’m pretty sure when my kids go away I’m going to turn up the nozzle and really go hard in my career work. You get to decide that. But be gentle with yourself, that boundaries are allowed to change. They can change over a few months, if someone’s ill they can change over a few years, they can change over whatever time period you need. And be gentle and graceful with yourself.

Kevin Pho: We’re talking to Shideh Shafie. She’s an emergency physician. Today’s KevinMD article is “Physician work-life balance: How boundaries protect you and your patients.” Shideh, you mentioned the art of saying no, and a lot of physicians have difficulty with that. So when you do coach physicians, just tell us about what that process is. Do they ever say, oh, it’s so difficult, it’s hard to say no? What’s that process in terms of getting physicians to change that mindset, and sometimes they need to say no to set those boundaries?

Shideh Shafie: So discomfort is part of growth, right? Discomfort is the currency of growth. Any time that you have grown anywhere in your life, you’ve been uncomfortable. When you took your MCATs, that wasn’t easy. When you’re applying in the match and stressing out, that wasn’t easy. The first time you learned to put in a central line, your heart beats a little bit fast, you’re tight, it’s uncomfortable.

And when you become an expert in life, most physicians are now experts in what they do, right, they’ve done all the hours of residency and whatever, and so when they feel uncomfortable they think something has gone wrong. And I remind them that saying no is going to be uncomfortable. It’s going to be uncomfortable at first, but then after they’ve done it 10 times or five times it’s going to get a little easier.

So I actually set a little bit of challenges for them. I ask them, let’s practice, let’s practice what it looks like. And I also, I personally love, if they’re up for it, I like them to practice holding discomfort in their body. I’m a big gym person, I love the gym, and I tell myself all the time when I’m at the gym, I have competitions with people at the gym that they don’t know about. So there’s a guy who’s super fit, lifts much more than me, and I’m like, I’m not going to stop until he stops, whatever reps we’re doing in our classes, and I’ll just keep going. And I’m like, this is so uncomfortable, and I remind myself, I can hold discomfort in my body, I can hold discomfort for a long time.

And as physicians we hold lots of discomfort that we’re used to, right, like not sleeping correctly, all these kinds of things, or having to pee for hours on end but we’re in the middle of a procedure so we can’t get out. We’re able to hold discomfort. Now we need to be able to hold emotional discomfort, the emotional discomfort of saying no to somebody and letting them be disappointed. Because the cost of not letting them be disappointed is to be disappointed ourselves, right? And so, who do you want to disappoint, yourself consistently over and over again, or is it OK for someone to be disappointed that you said no? And can you practice disappointing people who sometimes also want to extract things from you that are not so fair for them to extract?

So there’s kind of all those angles, practicing holding the discomfort, and also becoming more aware of, is it OK to disappoint someone who’s asking you to do something that’s just too much for you to do?

Kevin Pho: Discomfort is the currency of growth. Can I quote you on that?

Shideh Shafie: Yeah.

Kevin Pho: All right, Shideh, we’ll end with some of your take-home messages to the KevinMD audience.

Shideh Shafie: Create boundaries to protect your energy. You get this one precious life to live, right? You have to do the things that you want to do in it. Your whole life is not meant to be in service of medicine and the house of medicine. You have so many other things that you can do in your life, and it’s a wonderful, beautiful part of your life, but it’s not the entirety of your life.

So setting boundaries is a way to make sure that you get to all those other goals, whether it’s time with family, whether it’s your own personal goals. So create boundaries to protect your energy. And yeah, they’re going to be uncomfortable, but you can definitely do hard things. You’ve done harder things than saying no in your life.

Kevin Pho: Shideh, thank you so much for sharing your perspective and insight, and thanks again for coming on the show.

Shideh Shafie: Thank you.