Physician work-life balance: How boundaries protect you and your patients

“Shideh joon, can you talk to this woman? We met her at a party, and her kid is sick.”

This request from my father exemplifies the blurred lines between personal and professional life many physicians experience. He had met a mother at a party whose child, after being diagnosed with a virus and prescribed rest and ibuprofen, was still feeling unwell. She had, however, thought it a good idea to drive from the mid-Atlantic to Massachusetts to attend a Persian party. Despite being in the middle of weekend activities with my twins, I found myself on the other end of the phone with this woman trying to help, but also frustrated; I was suddenly drawn into providing medical advice—a role that, while natural to me was not the role I wanted to be in – I wanted to be a weekend mom, enjoying my time off, and it was not lost on me that this lady was at a party, instead of calling her pediatrician or going to urgent care, the irony was not lost on me.

I did offer the necessary reassurance to the concerned mother, emphasizing rest and follow-up care. However, this incident led to a crucial conversation with my parents. I explained that moving forward, I could not be called upon to provide medical advice outside my professional setting unless it was for direct family members. This wasn’t about reluctance to help but about preserving my own well-being. As an ER doctor with extensive family and professional networks, failing to set this boundary could mean working incessantly.

In the demanding realm of medicine, our identity is deeply intertwined with a commitment to serving patients and communities. Yet, without clear boundaries, we risk operating in a near-constant state of work, leaving little room for recovery or personal time.

Setting boundaries might initially feel uncomfortable or even guilt-inducing, particularly for those of us from backgrounds that emphasize community support, like my immigrant parents. However, this practice isn’t about withdrawing our services but about ensuring our longevity in the profession so we can be kind, empathetic, and compassionate – not crispy.

Healthy boundaries allow us to preserve our integrity, preventing resentment that can arise from feeling undervalued or overextended. These limits are not about diminishing our compassion but are essential frameworks that enable us to sustain our caregiving roles effectively.

Although setting boundaries may seem straightforward, the challenge often lies in their enforcement. Many of us desire uninterrupted time to recharge and may even communicate that boundary to our teams. But we find it quite difficult when the boundary we have set is “violated.” The thing about boundaries is they are not rules that people have to follow; they are boundaries that we have to enforce. The structure of a boundary is always “I will do X if Y,” for example, with my parents. “I will not answer if the medical need is not for a direct member of our family.” This means the next time my dad calls with a question for a friend, I have to redirect him and say they have to follow up with their own doctor. There is enough repetition, and people stop asking, but it can take a while.

I’ve also observed firsthand how maintaining boundaries can initiate systemic changes. In one ER where I worked, the evening sign-out process overloaded the nocturnist with three physicians signing out to them all at 11 p.m., and a whole area of new patients waiting to be seen. This unsustainable situation had some physicians staying late with unpaid overtime until that happened less and less as the situation became less bearable. You can imagine the nocturnists complained until changes were made to the staffing and sign-out procedures, improving conditions for all. If we remain the bandaids for these untenable situations, those who make the staffing decisions can be in the dark and shielded from having to make changes.

By firmly upholding our boundaries, we teach others how to interact with us, benefiting not just ourselves but also our colleagues and patients by ensuring we can be fully present and effective. In today’s world, where technology keeps us constantly connected, the discipline of boundary-setting is crucial. It’s a skill that enhances our ability to navigate the complexities of our profession with grace and resilience.

For physicians, establishing and maintaining boundaries is an essential skill set, especially in an era where we might always be found accessible across multiple platforms. This skill set, while initially may seem like it may limit our capacity to serve, it actually does the exact opposite- enhancing our capacity to serve, as well as our longevity in service.

A simple framework for setting boundaries:

Identify your needs. Determine what you require to feel rested and prepared for work. Clearly define these needs for yourself first, this will be the basis of your boundary.

Decide on communication. Assess whether your boundaries need to be communicated and to whom. If so, clearly and kindly communicate them.

Prepare for enforcement. Understand that even after communication, some may not respect your boundaries. This is a habit change, and habit change can be hard. It also may create a challenge for the violator, and so, of course, they will resist that change. Be ready to enforce them firmly yet respectfully. For example, the next time a similar situation arises, you may need to decline, as I had to with my father. This is often the most challenging aspect of boundary-setting. Don’t expect to get it right the first time, but keep committed to practicing your boundaries.

Create physical boundaries. Implement practical measures to support your boundaries. For instance, on Friday nights, I leave my phone in my bedroom while spending quality time with my family downstairs. This physical separation from my phone significantly aids in maintaining my personal boundaries.

Practice consistently. Recognize that it’s normal to let boundaries slip, especially in the beginning. The key is to persistently practice setting and enforcing them. Over time, you will become more adept at maintaining your boundaries, and those around you will learn to respect them.

Boundaries can shift. Sometimes boundaries will change over time or need modification, which is totally normal too. The boundaries we have when one has young kids at home are quite different than when there are no children at home. If a family member is ill, or we are ill, boundaries might shift.

Shideh Shafie is an emergency physician.

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