Establishing Professional Boundaries for Physicians

October 21, 2014

One of the challenges with physician work-life balance is maintaining boundaries - specifically when guilt gets in the way.

One of the challenges with work-life balance is our boundaries - specifically when our boundaries are not well-tended fences but rusty gates blowing open in the wind. Yesterday, I spent my typical day off in clinic seeing patients as I am going to be at a medical conference for the rest of the week. I was working with a new clinician who was shadowing me for the afternoon. Promptly after my last clinic patient, she let me know that she needed to get home as having dinner with her family was a priority. I imagine that cost her something – to admit to someone she just met that she was going to leave early so that she could eat dinner with her family. However, I respect what she did and the boundaries she set. In fact, thinking about it, I probably have a higher opinion of her because she has thought through how to establish her own balance.

I was asked to meet after work last night by a colleague with an urgent concern. Since I was going to be out of town and the issue was urgent, my colleague was quite anxious to meet last night. I agreed to meet, but did so realizing that I would be giving up dinner with my family on the only night this week I had the possibility to join them. I struggled quite a bit with where my greater loyalties should lie. The meeting took longer than expected (as they usually do) and I ended up arriving home just before bedtime, eating dinner by myself.

We have many boundaries in the practice of medicine. As a family physician, I cannot perform an appendectomy on my patient no matter how much they want to avoid the specialist's copay. I draw lines on prescribing both narcotics and antibiotics inappropriately. I have fairly set office hours (although sometimes bend these for patient requests). I charge each patient the appropriate fee without respect to their insurance coverage.

Personal boundaries often become more difficult to navigate. Recently, I was offered a new position, with increased administrative responsibilities. As part of my acceptance, I asked to maintain a four-day work week by working longer hours on the days I was at work. My boss agreed, but reminded me that while she had no problem with those boundaries, I was going to have to be diligent about maintaining them.

I think that's at the heart of boundary violations - respect. It's not necessarily other people's respect for our boundaries, although sometimes they don't like them or don't want to follow them. It is more often that we don't respect our own boundaries. I would argue that's either because the boundaries are unreasonable (I want to leave every afternoon between 2:30 p.m. and 3:15 p.m. to pick up the kids from school) or because we are uncomfortable with them (my co-workers will think I'm not a team player if I ask for this call switch). I guess my conclusion is this - if we don't respect our own boundaries, no one else will either. So, pick them thoughtfully and carefully, but maintain them as well.