Many of the physicians I work with bring up the issue of boundaries. “I know I need to set better boundaries, but.” They see the costs. They are clearly aware of what they need to do but just can’t seem to execute. They let patients drive the conversations in the exam room so that they run late and finish notes at midnight. They agree to a schedule change to help another clinician and then resent it. They say yes to their department chair’s request to be on another volunteer committee and end up juggling way too many balls.
They pay the price and they know it but can’t seem to stop. Why?
Physicians often tell me the problem is that they don’t know what to say to a patient, colleague, or boss in these situations. They believe all they need is a carefully worded script. I agree that having a script or two at the ready can be a valuable tool, but I’ve found that to really make changes you need to dig a bit deeper. Otherwise, you’ll never use those beautifully worded scripts.
Physicians are generally very altruistic. We want to help, and we want to solve problems. In addition, women physicians, like most females in our country, have been socialized to be nice, to be accommodating, to help out. It feels uncomfortable to say no and risk displeasing the person in front of us. We may believe that it is impossible to set limits and be a “good” person.
Real physician voices, twice a week
Free, and one click to unsubscribe.
But as Fran Hauser writes in The Myth of the Nice Girl: Achieving a Career You Love Without Becoming a Person You Hate, this is a false belief. Empathy and kindness can coexist with saying no and setting healthy limits. But knowing that isn’t enough.
I’ve found that when physicians take some time to really appreciate their natural tendency to do for others and to understand the benefits they’ve received from navigating life this way, they are then able to try something different. Beating yourself up for not being able to change a habit or pattern always backfires. Exploring the patterns with a kind eye toward yourself works far better.
So yes, find some scripts that work for you. Consider carefully which boundaries make sense, given the context, your career aspirations, your home responsibilities, and your phase of life. Appreciate your “niceness” and begin practicing setting some limits, starting with an easy one first.
As Brené Brown wrote in The Gifts of Imperfection: Let Go of Who You Think You’re Supposed to Be and Embrace Who You Are, “Daring to set boundaries is about having the courage to love ourselves, even when we risk disappointing others.”
This essay is cited in the KevinMD record on physician burnout.
Diane W. Shannon is a physician, professional coach, author, and health care writer who helps women physicians build influential, sustainable careers without sacrificing their well-being. She can be found at dianeshannon.com.
She brings more than 20 years of expertise in physician burnout, women physician leadership, and building sustainable physician workplaces. After experiencing burnout early in her own primary care career, she dedicated her work to understanding why talented physicians struggle and what it takes for both individuals and organizations to thrive. Drawing on her experience as both a physician and award-winning health care writer, she helps women physicians expand their leadership, navigate career transitions, and avoid burnout, while partnering with health care organizations to retain physicians, develop women leaders, and strengthen workplace culture.
Dr. Shannon is coauthor of Preventing Physician Burnout: Curing the Chaos and Returning Joy to the Practice of Medicine, a TEDx speaker, and cofounder of Lead Your Way Academy. Her writing on burnout, cognitive load, and physician well-being has appeared in Massachusetts Medical Society publications, the American Medical Association’s STEPS Forward toolkit series, and on WBUR. She shares updates on LinkedIn and Instagram.
