Breaking the Silence: Why Physicians Must Set Boundaries to Protect Their Well-Being and Patient Care

It was 9 pm when I received a text from a surgical resident about a patient. It was not urgent and I was not on call. I chose not to acknowledge the text until the following morning. Several years ago, I would have answered the text right away. As a physician, should I not be available at all times? That was my belief – until I realized that I was spreading myself so thin that I lost myself and my purpose.

Caring for patients does not mean sacrificing your everything. When you have a compromised physical or mental well-being, it is impossible to give your best to your patients. No matter what you do, the most important thing is to take care of yourself first.

Silence is not golden. If you do not speak up, other people will think it is okay to contact you outside of your working hours. If others do not have any guidelines on how to treat you, they may just follow their own rules or go with whatever is convenient for them. There is nothing wrong with it until that jeopardizes your well-being.

Setting boundaries and maintaining those boundaries are vital for physicians’ well-being. While many physicians understand this, quite a few are still having difficulty in setting clear work boundaries. It is time to get comfortable in saying “No”. Understand that “No” is to a specific task or favor. “No” is not directed to a person.

First, it is important for you to give yourself the permission to set clear boundaries. For example, set clear work hours. Let yourself stay away from work-related tasks when you are off duty. If you choose to think about certain work-related issues after hours, that is your choice. Do not feel obligated to do it. Respect your established work hours. If someone asks you to do something after hours, you get to decide what to do. You have to be the first person to respect your own boundaries before other people will respect it. If you are not clear cut on your boundaries, then other people will not help you uphold it. Make sure your colleagues, other staff members and your patients know about the boundaries around your work hours.

More on setting boundaries for your colleagues to respect. If you do not tell them, they do not know you have boundaries or what boundaries you have. Practicing medicine is not a lonesome task. It is a collaborative effort for the best patient care we can provide. When you feel overwhelmed, say, if it is related to the number of patients you are scheduled to see, or the complicated situation of a patient, ask for help.

It is important to set boundaries on break times. It is helpful to use time blocks. Allow yourself the break for lunch. Set times in between direct patient care to tackle your in-basket tasks and phone calls. I cannot emphasize enough how important it is to take small breaks, which are essential for you to refresh and recharge throughout the day.

With patients, it is important to set the boundaries clear from the beginning. Everyone’s boundaries are different. A doctor may be comfortable for his patients to call his cell phone 24/7, while your boundary is set at no contact by using your personal cell phone and no patient messages or calls after 5pm. If your patients do not understand your boundaries, they use their own expectations to measure against your behavior. If they expect you to pick up the phone at 8 pm and there is an answering service with another doctor on call instead, they may be upset. Working as a team is vital. Ensure everyone is on the same page. If a patient demands to have your cell phone number, the staff needs to know that they are not supposed to share that information.

Besides setting boundaries related to your work hours and guidelines for your colleagues, staff and patients to respect, it is important to set emotional boundaries. Many people have shared with me that they believe being an oncologist is very emotionally challenging. I am a human being and just like everyone else, I have emotions. I allow myself to feel them. When you try to suppress the unpleasant emotions instead of accepting them and feeling them, you will one day be so overwhelmed that you may break down. Yes, I feel with my patients, the happy, the sad, the good and the ugly. That does not mean that I am immersed in those emotions. It is important to remember what we, the physicians, are there for – to help our patients to the best of our ability using our expertise. While establishing an emotional connection is important, it is more important not to be drained or overwhelmed that your judgment is clouded.

Setting boundaries as a physician is crucial for your own well-being and for providing your patients with the best care. When you are clear on what boundaries you uphold and let others know them, they will learn to respect them. Set boundaries for your work hours, for when you are available. Set boundaries for your colleagues and patients. Know when it exceeds your limit and ask for help. It is important to respect yourself, take care of yourself physically and emotionally so that you can take care of your patients the best way possible.