When I think about boundaries, I am struck by how individual, varied, and unique each of our own personal definitions of boundaries can be. For one person, it is the physical boundary between the external world and our property. For another, the emotional and relational boundary between physician and patient. For many, the physical, emotional, and energy boundary between work and home. And often the most difficult, the boundary between our sense of responsibility to the needs of everyone else, and our own.
The one commonality I notice when I speak with countless women physicians about boundaries, is their almost visceral, gut response. A protective, defensive, and defiant outcry. One of “no, you can’t cross this line. I’m not ok with this. This is my line in the sand.” Followed immediately by, “I know this is a boundary I shouldn’t allow to be crossed, and yet I feel guilty. I feel bad, and so I give in.”
Why is this? Why does holding to our boundaries feel so hard? Why do we feel so guilty protecting ourselves? Why do we feel this is selfish?
When I look at the broader, larger picture of our culture of medicine, I am struck by how much we groom physicians to allow their own personal boundaries to be crossed from their very first days of medical school. We train our young doctors to respect the old dictum to not only “Do No Harm,” but to put the “Patient First” above all else. No matter if we are worn out, exhausted, tired, hungry, and have not slept or been able to attend to our own bodily function needs in days. We are trained from an early, impressionable age to put everyone and everything else before our own needs. This is what it means to be a doctor; this is what it means to care for the sick, the suffering, and the dying. We became doctors to help others, because of our deep desire to serve. Our sacrifice and altruism are admirable, but is this what makes us the best doctors? Is a doctor who has not cared for her own health, who works herself to the brink of burnout and exhaustion, truly an individual who is bringing her best self to the care of those in need?
Add to this dilemma our unique strengths as women physicians. There is now substantial data showing that we are more naturally collaborative and emotionally intelligent than our male counterparts. We are more aware of, and more likely to respond to, the needs of others. This is what makes us such incredible partners, mothers, physicians, healers, and leaders. And yet, there is the darker side to our innate strengths as women. We are more likely to suffer from emotional exhaustion and burnout, as much as 60 percent more, than male physicians. As women physicians, we have as much as a 400 percent increased risk of dying from suicide compared with women in the general population. 40 percent of women physicians go part-time or quit medicine altogether within six years of completing their residency training.
This is not only a huge problem — this is an epidemic. An epidemic of silence, pain, and suffering. Inflicted on ourselves.
When I talk with women physicians about boundaries and self-care, there is almost always resistance, followed by guilt. A feeling that they are being selfish. Why do we struggle to put ourselves first, to put on our own oxygen masks, before doing so for everyone else? What holds us back from caring for ourselves? Would we have the same guilt-ridden reaction if we were speaking with a close friend?
I think there is tremendous virtue in our unwavering commitment to our patients and their families. It is the privilege and honor of our lives to serve and care for others as healers and physicians. What we do not learn as students, trainees, or attendings — what is not imparted to us in our long and arduous education and training — is the understanding that in order to best serve as the healers and physicians we have the potential to become, that we have to first be strong and healthy in our own body, mind, and spirit. “Do no harm” must apply to us first.
The simple truth of boundaries is that they enable us to protect our most precious resource —our life energy as human beings, as women, and as physicians — so that we can be the healers we want to be, the partners and parents we want to be, and the friends and daughters we want to be. Boundaries free us, and free our souls. For each of us, what we need in order to not only conserve our energy, but to allow our energy to expand to its fullest and most fulfilled potential, is individual. It is completely personal. The answers are within us. Deep inside, only you know what you need most.
What do you long to have more of in your life? What do you need less of? What boundaries, whether soft and gentle, or firm, do you need to create for yourself? Where do you need help? Where can you ask for help? Where must you say “no?”
My deepest wish is for you to discover and create this sacred space for you. Boundaries start with you, from within. From this place of strength, you can create anything: a life you love as a woman physician.
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