Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes!

We sit down with Laura Suttin, a family physician, to explore the emotional complexities of setting boundaries, especially in times of personal and professional pressure. Laura shares her deeply personal experience of caring for her aging rescue dog and how it became a pivotal moment in learning to prioritize her own needs. We’ll dive into the challenges of people-pleasing, the guilt that can come with setting boundaries, and practical strategies for reclaiming time and energy.

Laura Suttin is a family physician.

She discusses the KevinMD article, “The heartbreaking decision that taught me the power of boundaries.”

Our presenting sponsor is DAX Copilot by Microsoft.

Do you spend more time on administrative tasks like clinical documentation than you do with patients? You’re not alone. Clinicians report spending up to two hours on administrative tasks for each hour of patient care. Microsoft is committed to helping clinicians restore the balance with DAX Copilot, an AI-powered, voice-enabled solution that automates clinical documentation and workflows.

70 percent of physicians who use DAX Copilot say it improves their work-life balance while reducing feelings of burnout and fatigue. Patients love it too! 93 percent of patients say their physician is more personable and conversational, and 75 percent of physicians say it improves patient experiences.

Help restore your work-life balance with DAX Copilot, your AI assistant for automated clinical documentation and workflows.

VISIT SPONSOR → https://aka.ms/kevinmd

SUBSCRIBE TO THE PODCAST → https://kevinmd.com/podcast

RECOMMENDED BY KEVINMD → https://kevinmd.com/recommended

GET CME FOR THIS EPISODE → https://kevinmd.com/cme

I’m partnering with Learner+ to offer clinicians access to an AI-powered reflective portfolio that rewards CME/CE credits from meaningful reflections. Find out more: https://kevinmd.com/learnerplus

Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome back Laura Suttin. She’s a family physician. Today’s KevinMD article is “The heartbreaking decision that taught me the power of boundaries.” Laura, welcome to the show.

Laura Suttin: Thanks for having me. Good to be here.

Kevin Pho: So you’re a family physician, and tell us the events that led you to write this article here on KevinMD.

Laura Suttin: Yeah, I wanted to just tell a part of my story that I know really resonates with physicians, when we are faced with having to make a choice about where we focus our time and our energy, and putting ourselves first in a lot of cases, because that’s not easy to do.

Kevin Pho: Yeah, so tell us a story that you shared in this article.

Laura Suttin: Yeah, this was about 10 years ago. My dog at the time, he was around 10 years old, and as he started to get older we knew that a time was coming where we would probably have to say goodbye to him. And so, lots of conversations with my vet. I was a single mom at the time, so I really felt like I was making the decision by myself.

Lots of conversations with the vet, and when it came time to where we knew we had to let him go, I took the call from my vet, and it was a Wednesday afternoon, I’ll never forget. I was standing at the desk of my then executive assistant, and she kind of overheard the call, she knew what was going on, and the vet and I made the appointment for that following Friday to say goodbye to our dog.

And so when I hung up the phone I was just numb. I couldn’t even think, I didn’t know what to do, I was overwhelmed with emotions. My executive assistant, again she knew what was going on, she said, go home, take care of yourself, I’ll clear your schedule, I’ll clear your calendar. And I did, and it was the best gift that I ever gave to myself.

And that was really one of my most powerful and impactful experiences of having to say yes to myself and saying no to everything else at the time, and just focusing on what needed to get done and asking for what I needed. It wasn’t something I was used to at the time.

Kevin Pho: I think a lot of physicians can relate to that. All through their training and all through their lives as physicians, they put others in front of their own interests as well. How difficult was it for you just to do that, just to take time off after that experience with your dog?

Laura Suttin: Yeah, it was difficult. I think part of what made it easier was because she knew how to advocate for herself and for others in ways that was maybe not easy for me at the time. So she kind of made the decision for me almost. She said, go home, I’ll clear your calendar. I don’t know if I would have done that on my own.

So I had somebody to help me with that decision, and I think as physicians, having somebody that we can bounce things off of, a mentor or partner or coach or whatever that looks like, can be really helpful too, because physicians aren’t used to doing that for ourselves.

We’re trained to sacrifice our own needs for the needs of everybody else, and we’re rewarded for it in our training. We’re rewarded for who got the least amount of sleep, who took the most number of calls while on call, who ate the least, who went to the bathroom the least. We ignore our own bodily needs, and we’re conditioned and rewarded for ignoring our own needs and sacrificing ourselves for the needs of everybody else. So it’s not easy to do.

Kevin Pho: And just to be clear, you said that it took your executive assistant, it took someone else to tell you to go home and take time for yourself after such a traumatic event. Because if you were left to your own devices, if you hadn’t made a decision to yourself, you may have stayed and done what you normally do and practice and continue to see patients.

Laura Suttin: Yeah, exactly. And so I think back to that incident now, because I’ve also powered through, right? I mean, that’s one instance where I didn’t power through. I have powered through so many times, and I think a lot of us have, and we can think back to those times.

And I can think back to those times and say, well, when I powered through, how effective really was I, and what was the end result on how I felt after powering through? Versus, no, when I took that time and when I was kind of told to take that time, then it really just meant so much to me and was necessary for me.

So I have those data points where I can go to and say, what’s going to really help me in the end? Is powering through? Probably not. Taking the time for myself and for what I need is going to be just so much more helpful.

Kevin Pho: Talk more about the effects of that culture of powering through. You mentioned before that a lot of physicians during our training were in fact rewarded for powering through. Does that have any detrimental effects on the behavioral health of physicians?

Laura Suttin: Oh, absolutely, and I think we’re all seeing that. And again, if we think about classical conditioning, we get a reward for a certain behavior. So we’re rewarded for powering through and for ignoring our own emotions and our own needs. We’re rewarded in the form of better grades, right, and we all want better grades. We’re rewarded, maybe we get a coveted internship or rotation, we get a letter of recommendation from our residents or our attendings, we get the accolades from other people, we get this badge of honor for not sleeping on call.

And so there are these rewards that we get, and our bodies internalize those, and we are so accustomed to that, that when we get to a point where we’re trying to do something different, or we recognize a need where we have to put ourselves first or honor those emotions, our body’s fighting against it. And that can make it really, really difficult, because it’s so unfamiliar for us, it feels unsafe for us.

And so, it’s been a while since I was in my medical training. I hope that training environments are moving away from that, because it is having such a harmful effect on physicians and culture.

Kevin Pho: So tell us about how this event affected you moving forward. Now that you experienced that time for yourself and had your executive assistant set that boundary for you, has anything changed going forward since that event?

Laura Suttin: Yeah, I mean, I think about another situation, where four years ago when my father passed away I did something similar at the time. There was a part of me that said, well, if I work it’s going to keep me busy, it’s going to keep my mind off things. And then there was another side of me that said, no, take the time for you and for you to grieve and to just be with what’s going on, and take your mind off everything else.

And so I did, I took the time that I needed for myself and my family. And again, that’s something I look back on and say I’m really glad that I did that at the time, rather than just trying to power through and muscle through.

And I think also, as a physician, as a coach, as a leader, I want to set an example for others around me, and I think that’s something that’s really powerful too. When we set those boundaries, other people see it, and we’re giving implicit permission to others to do the same things.

Kevin Pho: So as a coach, tell us some examples where physicians can set boundaries, maybe outside of a traumatic event or a family event. What are some common ways that physicians should set boundaries, say at work?

Laura Suttin: Yeah, I mean, I think everybody’s going to be a little bit different, but what I’ve heard from my clients and colleagues is just something small. So taking a lunch hour, or taking a lunch, 30 minutes, is something that is a big deal for a lot of physicians. And a lot of physicians don’t have a lunch, they either work through or see that extra patient. So that might be something. It’s simple, but it’s not easy, but it can really make a big difference.

I had one client who took a 15-minute walk every day at lunch, and it made all the difference in the world. So something like that, blocking out time on your calendar for a meal, or just reading an article that you want to read, or meditating.

Maybe saying no to that extra patient that walks in at 4:59 and you have to leave to go pick up your daughter and take her to her soccer game. That’s something that again, I think a lot of physicians feel this sense of obligation to our patients and our colleagues. So that might be another example of setting a boundary, or kind of putting ourselves first in some situations.

Kevin Pho: Now when you hear these stories from your colleagues or from your clients, that hesitance to create that boundary, is that coming from within, or is that coming from administration or any other external force?

Laura Suttin: I think it’s both. I mean, I hear both. I do hear a lot of external pressure, an external obligation, so that’s absolutely there, and I know that I felt it, I know that that pressure is there.

I think it’s really up to us. We can’t control the pressure that is exerted on us, but we can control how we respond to it, and we can control what we will put up with and what we won’t. And I think the more of us that can stand up and say, no, this is a non-negotiable and this is something that I’m doing for myself, then we create this groundswell of advocacy and kind of push back against other people really telling us what to do. So I do think it’s a combination of both.

Kevin Pho: So I want to talk about that concept of saying no and setting those boundaries, because there are of course different ways to do that. And sometimes by setting those boundaries you’re pushing back against the entire culture of medicine, you’re pushing back against that inertia that promotes that status quo against saying no. So how do you coach your clients to do that, because that’s of course much easier said than done?

Laura Suttin: Yeah, we really have to start with what’s the end goal. Because if the client is sitting in front of me and really feeling just this resistance to doing anything that’s going to make them feel uncomfortable, which that’s human nature, right, none of us seek discomfort naturally, we have to start with the why.

So why is it that you want to say no to that patient that walks in without an appointment at 4:59 p.m.? Well, it’s because I need to pick up my daughter and it’s really important that I go to her soccer game. OK, well, let’s start with that. Let that be your north star, let that be your guidepost. And when we can keep that in mind, then it takes some of the sting off of maybe some of that fear of saying no or setting that boundary.

Kevin Pho: One of the things that you write about in your article is the fear of others’ reactions when you try to set those boundaries. And it doesn’t have to be reactions from administration, sometimes even your fellow physicians, right? They’ll have a reaction to you setting those boundaries and they’ll make a judgment on you as well. So talk about some of the reactions that you’ve heard when physicians try to set boundaries.

Laura Suttin: Yeah, I mean, sometimes there’s this, like, well, who do they think they are that they can say no, or they can set that boundary, or they’re trying to ask for special treatment, or something along those lines.

And I mean, it’s, I’ve felt it, I’ve experienced it myself as a single parent for many years. I fought against that and noticed that from other people kind of commenting like, well, does she think she gets special treatment because she’s a single mom? So I get that.

I think one thing that we have to remind people of over and over, and I remind myself of this all the time, is I can’t control somebody else’s reaction. And people are going to think what they think and they’re going to say what they say, and their behavior is a reflection of their boundaries or lack of boundaries. Maybe there’s some jealousy, that the other physician might be thinking, well, I wish I could ask for that, or something along those lines. It’s really a reflection of their own fears and own insecurities, and it’s not a reflection of what you might be asking for, what you might be doing.

Kevin Pho: So it sounds like a little bit of a reframing, right, whenever people have a reaction to when you try to set boundaries.

Laura Suttin: Yes, yeah, and we can’t control it. And if we try to manage other people’s emotions or behaviors, that’s going to take up all of our energy, and it’s a waste of energy we could be spending on other things.

Kevin Pho: One of the things that you said earlier is that if multiple physicians set boundaries, it could create that ripple of change and even influence others around them. Is there an example where you’ve heard or coached someone to set that boundary and it really created that systemic change within an organization?

Laura Suttin: Yeah, I mean, I don’t know about systemic change, but I’ve seen multiple examples where coaching a client through setting a boundary and advocating for themselves, and then they come back and tell me that, yeah, my colleagues are now doing the same thing, and even my staff is doing the same thing, or my patients are doing the same things.

And then so we start to see, like you said, this ripple effect, and this notion that again, when I set a boundary other people see it, and then we start talking about it. And it’s really magical how it happens, and then people start to take notice. Enough people kind of set boundaries in the same way, and then it just becomes hard to ignore.

Kevin Pho: I want to get a sense of the process it takes for a physician to set that boundary, because we’re talking about this on a short podcast and I don’t want to give the impression that this is something that happens instantaneously, right, that after one coaching session they’re able to set a boundary like that. Talk a little bit more about that process and how long it can take for some physicians to comfortably do so.

Laura Suttin: It can take a very long time. I mean, it’s something that I write about, and it’s still practice for me. And so yeah, after one coaching session, certainly not going to do it. And that’s why when I work with clients I typically work with them for several months at a time, because even if you start small there is going to be some resistance, so you’re going to feel uncomfortable.

And then so part of the process is how to manage through those emotions that come up, and how to talk to ourselves, that self-talk, self-coaching, so that when we hit that resistance or hit that discomfort, which is natural because we’re doing something new and different, that it doesn’t stop us and that we continue moving forward despite the discomfort.

So working through the emotions, having compassion for ourselves, is a huge part of the process. And I detail all of this in my book that’s coming out in October. Really starting from the beginning, like we said, start with the why, start with your values, and then here’s how to work through all of the steps that have to take place. And a lot of times it’s iterative, and it’s maybe one step forward and two steps back at first, until it gets easier. Just like anything, it gets easier with time, it gets easier with practice.

Kevin Pho: We’re talking to Laura Suttin. She’s a family physician. Today’s KevinMD article is “The heartbreaking decision that taught me the power of boundaries.” Laura, we’ll end with some of your take-home messages and tips to our clinician audience.

Laura Suttin: I would say start small and just practice. What’s one boundary you can set? What is the small action that you can do that can create some momentum in your life? Take action, and action is really what builds, what creates confidence. We tell ourselves we have to be confident, or we have to be ready before we do something, and it’s really action that creates that confidence.

So start small, build some momentum, and then go from there. And get some help. Don’t do this alone. Get some help from an accountability partner, a coach, a mentor, somebody that can help you through the process.

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

Laura Suttin: Thank you for having me.