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May 2023 - Dr. No: Holding Firm (but Friendly) Boundaries as a Physician and Leader

It's very common for physicians to have boundary issues related to time, demands of patients, and administrative tasks. Setting healthy boundaries and holding them is important for managing the daily cost to mental and physical health, relationships at work and at home, and general happiness and life satisfaction that a lack of personal limits can result in. In this session we learn about strategies and techniques to begin practicing the art of boundary maintenance. 

Session Summary

Session Host: Michele Hannay

Session Objectives:

At the end of this webinar, you will be able to:

  • Explain the neurobiological responses that make setting boundaries and saying no difficult.
  • Describe practical strategies for successfully setting and maintaining boundaries in a busy clinical practice – and beyond.

 

Recommended Resources:

  • Session Recording
  • Brene Brown, Braving the Wildness: The Quest for True Belonging and the Courage to Stand Alone
  • Jillian Horton, M.D., We Are All Perfectly Fine: A Memoir of Love, Medicine and Healing

Session Highlights & Themes:

  • When we feel threatened, our bodies respond just like they did when we frequently encountered wild animals as primitive humans - we go into survival mode.
  • This can be fight, flight, freeze - or fawn (do and say anything to de-escalate the threat)
  • Saying no and setting boundaries creates the risk that we will be unliked or shunned.
  • This triggers 2 of the 5 primordial fears – fear of separation and fear of ego death

Tips to manage people pleasing:

  • It’s an automatic response, but when you’re aware of it, you have a choice!
  • Sometimes ‘no’ is a full sentence - avoid a list of excuses and keep it brief.
  • Start small with someone ‘safe’.

Tips for managing shame:

  • Shame cannot exist in the light – talk about it.
  • Consider using a mantra that you can say to yourself if saying no is hard for you.
  • Examples:
    • I’m the guardian of my time and energy
    • I’m allowed to say no
    • I’m enough just as I am

Tips for setting boundaries:

  • Think about what really matters to you – what are your priorities?
  • What specific boundaries would help you achieve those priorities?
  • Work on one at a time.
  • Remember that you can only control your own actions and responses.
  • You can’t control how another person responds.
  • Beware of leaky boundaries – some people will push to see if you will give in.
  • Manage expectations – for example, patient often don’t realize that a standard appointment is 10-15 minutes.
  • Give cues like, “In our 10 minutes today, what’s most important for you?”

Tips for saying no to patients:

  • Get to the underlying issue – the patient may be asking for antibiotics, but what they really want is relief from symptoms.
  • Mirror to develop understanding – connect with the patient by mirroring their language.
  • Reframe the solution – instead of saying no to their ask, you’re saying yes to their underlying issue (e.g., Rx for anti-inflammatory, not antibiotics).