This month we’re focusing on boundaries, a topic near and dear to my heart and mind. Boundaries help keep us functioning at our best by creating the space we need between ourselves and other people, events, and things.  

Other people don’t know our personal boundaries unless we tell them in some way, verbally or non verbally.  Often, with some people and situations, you can’t just suggest a boundary once. You have to keep reinforcing them as needed.

Here are some examples that I used to make my work/life balance better.

When I first started practice, I would get work calls/pages during scheduled time off—weekends, vacation time. Eventually, I learned to set email/EMR out-of-office notifications. I had a separate phone for work. That phone stayed at home when I was away and in my car over the weekend so I could separate myself because the pull of responsibility was too great if I was aware of the call/text. 

My partners were covering. They had both my phone numbers and could easily reach me if it truly was something urgent that I personally needed to attend to. I also found it just confused people if I answered and they had also called the on-call doctor. 

Boundaries are not just for you. They are for other people as well. The boundary creates clarity about expectations and responsibility.

Here is another boundary I needed to make. We had a referring pediatrician whose office would always call on a Friday with “an emergency, must be seen today” and we would always squeeze his patients into those clinics. Only to find the fractures were almost always at least a week old, usually of a finger, and not displaced. They barely needed any treatment and certainly not on an emergent basis. 

One Friday when he called for this last-minute appointment, we were already very overbooked. I had the staff confirm that the fracture was, as usual, not displaced and had happened over a week ago. And I said NO. It did not affect his referrals to me, even the Friday afternoon “emergencies”.

I had a partner in practice a number of years ago who started to call me when he was on call for our pediatric ER. He primarily did adult sports medicine. At first, I always answered the phone. Then I started noticing that it became a constant thing, and not just complex peds stuff but more routine fracture care. It wasn’t that he didn’t know what or how to take care of the patient, but that it was easy for him to pass it along to me, even though I wasn’t on call. I’m always willing to help a fellow physician, but I also noticed if I truly wasn’t available, like out of town, he would just take care of it and not call our more senior partner. 

Instead of getting angry and resentful, I took steps to create a boundary for myself. I programmed my phone with his last name and DONT as the first name. That DONT gave me the pause I needed to decide before I answered the phone if I wanted to be available for him immediately or let it go to voicemail so I could see if this was a situation where he really needed my help.

We may initially think we are being mean when we start exercising our boundaries, but boundaries are an act of compassion. Compassion for ourselves and others. Compassion for ourselves because we can better maintain our energy and goodwill. And compassion for others because boundaries provide clarity.

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