Setting boundaries as a physician doesn’t mean caring less

For years, I thought good doctors always said yes.

Can you squeeze in one more patient? Yes. Can you answer this message before you leave? Of course. Can you finish this chart tonight? Yes. Can you take care of just one more thing? Absolutely.

It rarely felt like a major decision. Each request seemed small. A few more minutes. One more patient. One more message. But small yeses have a way of adding up.

And somewhere along the way, I began to believe that being a dedicated physician meant never disappointing anyone. Not my patients. Not my colleagues. Not my employer. And certainly not myself.

After many years in primary care, I have come to believe something very different: Caring deeply does not require being endlessly available.

The quiet pressure to always say yes

Medicine attracts people who want to help. That is one of the things I still love most about our profession.

A patient needs us, and our instinct is to help. A colleague is overwhelmed, and we step in. The schedule is full, but someone needs to be seen, so we find a way. The inbox keeps growing, so we stay a little later.

And because physicians are remarkably good at functioning under pressure, we can keep doing this for a very long time. That may be part of the problem.

We become so good at carrying an unreasonable load that eventually the unreasonable starts to feel normal. We stop asking whether the way we are practicing medicine makes sense. Instead, we ask ourselves whether we can handle it. And we as physicians can handle a lot. But “I can handle it” and “I should continue living this way” are two very different statements.

There is always one more thing

One of the hardest lessons I have learned in primary care is that medicine will take as much time as we are willing to give it. There will always be another chart. Another result. Another message. Another refill. Another form. Another patient who needs something.

For years, I could finish an exhausting day and still go home thinking about what I had not completed. I would rarely think about the patients I had helped or the dozens of decisions I had made. My mind would find the unfinished task. And the question would come: “Did I do enough today?”

I no longer think that is a very useful question for physicians. Because in medicine, the answer can almost always be: no.

There is always more we could do. So I began asking myself a different question: “Did I do what actually mattered today?”

That small change has made a profound difference in the way I think about my work. Doing what matters and doing everything are not the same thing.

Sometimes good medicine means saying no

There is another kind of “no” that physicians have to become comfortable saying. Sometimes a patient wants a test we do not believe is necessary. Sometimes they want a medication we do not believe is safe. Sometimes they arrive with several concerns that simply cannot be addressed thoughtfully in a rushed visit.

Earlier in my career, disappointing a patient bothered me deeply. It still does. But I have learned that making every patient happy and practicing good medicine are not always the same thing.

Sometimes caring sounds like:

• “No, I don’t think that test will help you.”
• “No, I don’t think this medication is the right choice.”
• “We may not be able to solve everything today, but let’s start with what matters most.”

A patient may not always love that answer. That does not automatically mean we have failed them.

Our responsibility is not to say yes to everything. Our responsibility is to care, listen, think carefully, and recommend what we believe is right.

Boundaries did not make me care less

For a long time, I worried that boundaries would somehow change the kind of doctor I was. Would patients think I cared less? Would I become less available? Would I lose the relationships that made primary care meaningful to me?

What I discovered was almost the opposite. When I stopped trying to give medicine every available piece of myself, I had more of myself to give when I was actually with my patients. I could listen better. Think more clearly. Be more present.

And perhaps most importantly, I could leave work with enough energy to still be a person outside of medicine. That matters.

Physicians have families. We have friendships. We have interests. We have bodies that need sleep. We have lives that should not begin only after every chart is closed and every inbox message has disappeared. Because that day may never come.

I no longer want to be the perfect doctor

After many years in medicine, I no longer want to be the perfect doctor. I am not even sure such a doctor exists.

I want to be a good one. I want to listen carefully. I want to keep learning. I want to recognize when I do not know something. I want my patients to know that I care about them. I want to go home knowing that I gave the people in front of me my best.

But I also want a life. And I no longer believe those two things are in conflict.

Perhaps one of the most important lessons we can learn as physicians is that our value is not measured by how much of ourselves we are willing to sacrifice. You can care deeply and still have boundaries. You can be an excellent physician and still go home. You can say no and still be compassionate. You can love medicine without giving medicine every piece of you. I wish someone had told me that much earlier.

So now, when I find myself automatically preparing to say yes to one more thing, I try to stop for a moment. And instead of asking: “Can I do this?” I ask: “Should I?”

For physicians, those may be two of the most important questions we learn to separate.

Jerina Gani graduated with high honors from medical school in Albania, Europe, in 1992. She later earned a Master of Science degree in Health Services Management from the London School of Hygiene and Tropical Medicine in the United Kingdom. In 1995, she relocated to the United States and completed her residency training in internal medicine in Brooklyn, New York. Since then, she has practiced as a primary care physician in Boston, Massachusetts. With decades of experience in the medical field, Dr. Gani is deeply committed to transforming primary care into a model of success and balance. Her professional focus emphasizes improving health care delivery while maintaining physician well-being. Dr. Gani shares her insights and strategies for achieving these goals through her platform at Dr. Gani Secrets, where she engages with health care professionals and the broader community.