World events have me thinking about boundaries. Countries have boundaries. Often they are based on the land’s physical features, but not always. Boundaries are created over time and may need to change for various reasons. So too with our personal human boundaries. When we speak of personal boundaries, we can mean the physical boundaries of our skin. Or we may mean the psychological or social boundaries that we live with and sometimes without. These boundaries can protect us and keep us safe from harm. They set expectations for how we want to be treated. And what we won’t tolerate. Personal boundaries are something we’re born with. Ever been around a newborn or a toddler? They have NO problem with their own boundaries (other people’s, well, that’s not something they are developmentally able to understand). Their personal boundaries are then socialized to what’s considered acceptable or desirable in their environment as they grow up. I can still remember being a child and being told to kiss my Grandmother’s cousin “Twinnie.” I was in elementary school. I had just met her, and I didn’t want to kiss her. I remember being aware of this and that it was expected of me by the adults I loved, trusted, and wanted to please, so I did. But I didn’t like it. That not liking was a personal boundary I allowed to be crossed. I think of the times a new doctor comes into the clinic or the operating room and is immediately bombarded by a slew of personal questions from the other personnel. Where are you from, why’d you move here, are you married, do you have kids? This always felt invasive to me (and after my second move in practice, it made me never want to move again.) No one else in the rooms ever seemed to think it was as invasive as I did, but admittedly, I have firmer, closer boundaries than most. I sometimes think we are so used to knowing everyone’s personal business that we can feel entitled to it in health care, even though the relationship is not between a health care worker and patient. There can be a real social cost for holding your boundaries. If you don’t answer these questions, you get labeled unfriendly or a bitch. But if you do, you may get angry or resentful because your boundary is being crossed. There’s also a physical cost for allowing it. The subsequent emotions can make you tense and lead to a more negative mood if you’re not managing your thoughts. For example, I could also decide that answering a few questions is a small price to pay for peace and acceptance in the operating room. There are different societal expectations for boundaries in different settings. In the example above, asking rapid-fire questions of someone who is new is done pretty frequently where I’ve worked. But if you met someone out in the world, you probably wouldn’t see the same pattern. You’d see more of an exchange between two people who just met each other socially, not one person essentially taking a history from the other. But medicine has very unique boundaries and is often unequal. The health care worker will ask many invasive questions of the patient, often without thinking twice and certainly without divulging the same. These implied boundaries are expected and considered professional. One thing about being a doctor that I never considered before making my career choice was that my boundaries would be violated again and again. That it was also expected. That I would consent without ever being asked. The interrogation from staff in a new position was just the tip of the iceberg. The deeper, larger part of the iceberg is that my human physical boundaries around sleeping and eating were not my own. Nearly every medical student has heard a version of “eat when you can, sleep when you can, and don’t touch the pancreas.” In some ways, it’s sage advice because, in training, you have limited control over those activities. Instead, they are dictated by the events around you. If there are patients to be seen, your physical needs are expected to wait. And that can become a lifelong pattern to put the needs of others ahead of your own. And if you do, you’re usually labeled a “good doctor.” But you may not be a happy one. Putting the needs of another above your own is only one pattern that leads to loosening of your boundaries. Another is people-pleasing. When you’re people-pleasing, you tend to do what you feel others expect of you rather than what would please you. A lot of people pleasers go into medicine. And then become resentful of how they’ve been taken advantage of. As an attending, you have more control over your boundaries, physical and otherwise. But, patterns persist. And there are many areas where our thinking still doesn’t allow for the exercise of our boundaries. And even more where it is not culturally accepted within medicine to choose yourself first. I often see boundary-crossing with people who want to leave medicine. The responses are varieties of the idea “how dare they?” He can’t leave his patients and practice. They can’t leave their partners high and dry. She should be in practice for a long time after “taking a spot.” It’s as though people aren’t allowed to ever make different choices in their adult lives because those lives are “owed” to their profession. This seems like the ultimate form of boundary-crossing. Your life isn’t your own anymore because you chose to go into medicine in your early twenties? That’s ridiculous. You may experience pushback from other people if you start making different decisions around your boundaries. Especially if they’ve benefited from your lack of boundaries in the past. But that doesn’t mean it’s not your decision to make or that you don’t get to make a different, more aligned one, in the future. Interpersonal boundaries don’t have to be permanent and may best be kept fluid depending on the situation and the people involved. It may take some experimentation to figure out exactly where you want certain boundaries to be. Try setting some firmer boundaries and see how you feel. Or try looser ones and see how that fits. You have the right to decide on boundaries that work for you. Boundaries that allow you to be personally and professionally satisfied a. Sometimes it means changing your situation. Sometimes that means changing your boundaries. And sometimes it means changing your thoughts about your situation. Source
