161. Boundaries In Medicine That Protect Time And Energy

Have your default answer no longer be yes if there can always be a pause. My schedule's really full right now. Let me take this home and think about it. So not giving a yes right away and remembering just because you can doesn't mean you should.

Are you a woman in medicine, feeling overwhelmed and disconnected from the personal fulfillment that you desire? You're in the right place. Join doctors Joanne and Erin as they rewrite the rules for women in medicine. Let's begin.

Why are women physicians praised for being team players, but penalized the moment they say no? Why does protecting our time, energy, or well being still feel risky, rebellious, or selfish? This is the hidden curriculum in medicine, the unspoken training that teaches women to over function, over give, and override their limits. In this episode, Erin and I are rewriting that script. We're talking about what boundaries really are, why they protect both physicians and patients, and how women can set them without guilt, apology, or fear of backlash. So, Erin, so excited to be here with you. Let's get right to it. When we talk about boundaries in medicine, especially for women, we what do we.

Actually mean when we're talking about boundaries? It's about having clear rules about your time, your energy, your availability, and your workload that are going to protect your ability to function sustainably. And I know you and I recently had a conversation about kind of burnout, proofing your life and making it so that you don't have to run or escape or burn out before you do a reset. And so boundaries are one of those key pieces that when you set limits, it's actually going to help you do more with what you choose to hang on to while letting go of those things that aren't serving you. And so that's where being really mindful of the yeses that you give and making sure that they're in alignment on many levels and not just, you know, that, oh, I would be the best person to do this job, of course you would, but do you have the capacity? And so it's really looking at also, what's the reason behind the yes? Is it. Are you feeling guilted into it? Is it because there's no one else who will take the job so you feel obligated? And so sometimes it's unpacking. People talk about the five or the seven layers of why. Why do I feel compelled to say yes? Why do I?

Why?

Why is that? And kind of digging deeper to make sure that it's not just this automatic habit that we've become so used to and really the norm by saying yes to too many things and not recognizing maybe what the collateral damage might be by not having better boundaries.

Such an important conversation. I think it's so important to talk about boundaries. And we, we wonder, we are good at so many things. Why are boundaries difficult for us and that we need to start there too with that compassion. Then we don't have the best role models, especially in medicine. But as women in general, we're socialized to take care of people, be strong, be emotional, be there for others. And saying no and protecting ourselves seems like a contradiction to that. And it's learning. Where do we set that line where we don't think of boundaries as pushing away or the negative side of saying no, but rather I always like to talk about it and as like this beautiful fence around you that's well defined so that you actually protect what's important. But I do believe that it's. We need to start also with the compassion that they are difficult. If not, we wouldn't be having this conversation and that it is appropriate to feel guilty or have that backlash when, when we said it. And that's actually where the work is. Once we said it, how do we keep it? Knowing that we might feel bad and that's kind of part of the process, but the reminder of what are these boundaries meant to protect in this season of our lives? And knowing that we're conditioned as women and as physicians to break that boundary. So I'm glad that we're here talking about this important subject and the awareness.

I was just on a group coaching call not too long ago and one of the clients stated, you know, I was stretched so thin, I wasn't doing a great job at any of my roles. And it wasn't until they got this awareness, oh, this is what it feels like to be a little bit less stretched thin. And this is better. And so part of this talk about boundaries is how can our listener even become more aware if they are over committed and as you said, role models, what does that even look like? And if everyone around you is over committed, are you willing to maybe be different and see what that's like? And as we've shared through so many episodes before that we tend to be rule followers and it's uncomfortable to step out of that norm. And yet the norm in medicine right now, especially for women physicians, is still about a 50% burnout rate. And neither one of us want to see that continue. So how can we get out of that and do a better job and setting healthy, clear boundaries and being okay with it is Certainly one of those steps that can help.

Definitely. And we talked a little bit about it already, but especially when we think about the women that we coach and would love to hear some examples. Why is boundary setting especially critical for women physicians right now?

As I shared, you know, with burnout rates being around 50% for some professions, even more for the last several years, that's not sustainable. And so for women physicians, keeping in mind there are a lot of tasks that still get asked. Women in professional fields that are maybe unpaid, heading up some committee, taking a role that is beneficial for the organization, but doesn't actually, it's not an actual promotion or bring in extra income. So sometimes we're often asked as women to take on those roles compared to male colleagues. And then in our households, we also have more roles. Uh, we just. I shared some of this on a previous episode about gender differences. Episode 1 54, where women in the household, more household chores, more childcare duties, which adds up to hours per week. So even as a woman physician, you are likely still holding on to more of the extra duties in your household, and that's a burden. And so when we can take an assessment, what's your role in the household? What's your role in the office? Have the other people that you're in those environments with write down what are their roles and raise awareness. And so you may be doing some things they're not aware of and vice versa. But if you are feeling chronically overwhelmed, overburdened, tired, you don't have enough time for a good night's sleep, then reassess. And what, what I would recommend doing to raise your awareness is recalibrate. And so I have an example for one of my coaching clients. She was in a leadership role for a statewide position, not paid. It was a volunteer, I believe it was a volunteer position. And when she let that role go, her normal would have been, oh, is there another role? Can I sit on a board? What else can I do? And she fought that urge. She chose to invest in her own self care, connecting with her spouse. And now she's recalibrating and she's got this kind of, now I have time, I can exercise in the morning, I can connect with my spouse. I'm not pulling so much into my free time. So now there's some capacity to breathe. And I don't think she'd experienced that in a long time. So I see her recalibrating and saying, oh, I think I want to ratchet down what I commit to because this feels more doable. I'm not so stressed.

So important. We were talking in one of our recent episodes too, about coaching and how coaching can help you. And this is one of the things that I probably help women in medicine the most. And one of the, probably the most common testimonials I get is it is easier for me to set boundaries. And also because you have clarity of the things that you want, where you're at and what's a priority in this time of your life. So then that way setting boundaries makes sense because I think we often ask ourselves the wrong question of can I say yes to this? Can I do it? Can I fit it in? And we say sure, like, and we might feel good that we're adding more things because that's how we're wired. And I like to ask myself this question of saying, if I say yes to this, what will I have to say no to later on? Or if, if I say no, what would it open up space for? Or is, am I staying true to myself if I say yes to this with what I am prioritizing right now, which can change almost month to month. That's why we have to have such clarity. And, and I think we also need to redefine. I think when we think of boundaries, at least I still have like, almost like a little bit of a negative connotation and I have to quickly catch it and be, no, no, no, these are good. This. Boundaries are meant to be protective for what's important. It's not like a pushing away, which we would be resistant to doing. So this is definitely good, good ongoing conversation for us to have. That's why we keep on bringing up this topic. It's so important.

And I want to highlight what Joanne said about in the running a group coaching cohort where we are intentionally creating communities that are choosing to have different norms and different outcomes than what is typical. And it's role modeling. And when you're seeing other women healthcare providers making decisions and creating clear boundaries and enjoying the benefits, now we get to see a different kind of role model. And as we lead these sessions, encouraging them, I, I've, I've celebrated with some of my clients quitting something, whether that was quitting their job, for some of them it might have been quitting a relationship, quitting a degree program because it didn't fit the season of their life. And they realized that I'm going to set a boundary there. And that isn't normal for us in medicine to celebrate quitting something. And sometimes we could learn to learn to quit things and There's a little tangential from boundaries, but it's actually, I don't have the bandwidth, or maybe now I have the recognition that this is not great for this season in my life. And so I'm going to turn my yes into a no and be okay with that. And can we recognize that holding onto something just for the sake of proving you can do it, who's that serving? Really digging deeper and asking ourselves, why am I doing this? Am I afraid to quit something for some reason that has nothing to do with the relevance of what's going on in your life right now?

Yes.

So important.

And for the women who is listening, who feels completely overextended or terrified to say no, what are some other boundaries that she can start practicing even this week?

One is to have your default answer no longer be yes if there can always be a pause in there. My schedule's really full right now. Let me take this home and think about it. So not giving a yes right away and remembering just because you can doesn't mean you should. And then really asking yourself critically, checking in with your spouse or your partner, asking your colleagues, is there someone else who can do this? And then if you are going to say yes, is it an enthusiastic yes, are you going to show up because, oh, I love doing this and you're passionate about it, versus you're doing it because maybe no one else is volunteering to do it or because you feel guilted into doing it. And I would challenge you that those aren't great reasons to do it just because no one else will, or just because you feel guilty about it, you might be serving in a different capacity in other ways that better fits your needs and your capacity right now. And it may not be the right season for you. So one is be really protective of your yeses. And only if things are excellent, well aligned and you have capacity, should you say yes. And if you don't have capacity, it's not well aligned and you're not super enthusiastic, then turn that into a no. And we've talked before about, you know, I'd love to help. Now's not the time. Maybe ask me next year and I might have a different answer. But not committing just out of guilt, other ways that you can set boundaries is to create rules when you're in a good mindset. Maybe it's on the weekend for me. I reflect on Sundays, I go through my planner, I look ahead at my week, and I schedule how are things going to look. And when I was doing patient care, one of the Rules I created was I was going to leave the office and shut down my charting, shut down my work by 6pm and before that I would stay there till 7, 8, 9, 10 in the early days, 11 o' clock at night, and then I would get back into work over the weekends. And I created kind of no charting zones, no work zones. And if you can do that, then what you're going to do is compress your work into a specific time zone. And it might then force you to make different decisions, set different boundaries during your workday in order to be able to play by that new rule that I'm going to finish up by whatever time that is for you. And my hope is for my clients. I try to help them make it so that they're not at the office or doing more work after their patient care, more than about 45 to 60 minutes per day. And so if you're pushing way beyond that, then what are the things that you can do to shrink that down? So protecting no charting, no work zones, I'm putting air quotes up for that. And so saying something like, I finish my notes before I leave or if not, I'll come in early tomorrow before work. And you know, my home's not an extension of my, of my clinic. Another one is delegating, looking for, you know, if this is not something I enjoy doing or I really shouldn't be doing it, maybe it's administrative work that you're doing and you really should be focusing on your clinical work. Who else can take that on? Is there somebody else who this falls onto? And you just told yourself, I'm just going to do it because it's easier or more simple. But now you're adding time to your work week regularly and what would happen if you offloaded that permanently to someone else? So delegating and doing it without guilt and without this need to apologize because those don't really help your mindset, how you feel about something. You're handing it off with joy. Now I can really focus on things that I need to rather than I handed this off and now I still have this energy attached to this job that I gave to someone else, but I'm feeling guilty or I'm feeling bad about it. You're going to minimize the benefits that you could otherwise be enjoying. And my hope is not to, not to do that. And then lastly is communicating your limits. Whether that's communicating limits to your colleagues, I can't add any more add ons to my schedule or I've got this going on. And so I might have always said yes to that and I'm not going to do that anymore. And also communicating limits at home to your spouse, your partner, your kids, and just saying like, I know that I've been owning this thing and I need to share this load. What can you do to help me make that happen? And then find what's the win in it for them? There's a three part influence model that I think Joanne's familiar with too, where you're acknowledging, I know I ask a lot of you and then you find the win for them. If you're able to take this off my plate, I'm going to be able to focus and have more energy at work so I can wrap up my day and I can be fully present and engaged by dinner time. And then what's the emotion that is helpful to overlay that? Excitement, enthusiasm, whatever that emotion is. And that's a technique I commonly share with my clients in order to help use influence in a positive manner, in order to help others engage with that, that outcome that you want to see. And that can be very helpful when delegating to others.

I am so glad that we're having this conversation because I think of boundaries almost as going to the gym is work that we need to keep on practicing and improving to build that muscle. And Erin gave us, we love formulas here. So I'll repeat it in a formula matter of, in summary of what we can do. You can pause and then you don't have to answer yes right away. I like to say, let me check my schedule and I'll get back to you. Create rules when you're feeling well. I, I usually say Sunday morning Puerto Rican coffee is my best time. So find that for you and limit the time that you're gonna spend, especially if you're doing anything outside of your work hours. Delegate. We have such a hard time with that one. But it's so important. Reframe the emotions around the boundaries. And then of course, communicate, communicate, communicate and understand that some boundaries are also internal. So what is the conversation that you have to have for yourself? And with that, I would challenge you to think of what's one boundary that you are willing to practice starting this week. And we would love to hear what that is. So if you haven't, go to our YouTube page, the link is in the show notes and you can leave us a message there, you can leave us a comment, share. Was that boundary there? We'll share ours as well and that way we can learn from each other. And with this, stay tuned because our next episode is coming right up.

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