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Setting Boundaries – Skills for Survival

One of the strongest assets I’ve acquired over the years is the skill of setting boundaries. It’s an asset that can be applied to all sorts of scenarios, but it’s been instrumental in surviving the career of medicine.

Setting Healthy Boundaries

One way to set boundaries is to dig in your heels and reject all things outside your comfort zone. It’s a radical way of setting boundaries and perhaps a good place to start. But it’s also alienating and exhausting.

A healthy boundary is one that creates some balance wherein you feel some room to breathe while allowing those around you to feel included in your life.

I’d love to see you today but I don’t think I have the energy.

In professional situations, I may want the income from a particular type of job, but I know that if I transgress my boundaries, I’ll resent myself and the job.

A $600k base pay with an endless ceiling sounds great but I’m not willing to give up my weekends and my evenings.

Building Boundaries Step by Step

In medical school, I sacrificed my mental well-being for late-night study sessions. And I judged my value based on the scores I got compared to my peers.

In residency, I let attendings and senior residents berate me or place me in uncomfortable situations without speaking up.

Who knows how much of that resentment I still harbor? Fortunately, I’m much kinder to myself these days – a lot more forgiveness and setting time aside for emotional well-being.

By 2012, after giving it my all at Kaiser Permanente for 3 straight years, I decided that pleasing others is a thankless and bottomless proposition. I began to set boundaries, starting with my health, diet, and eventually emotional well-being.

Lifestyle & Health

This was the easiest for me because I suffered the most in this arena. My digestion was fucked, my sleep was terrible, and my acne was out of control.

I set boundaries for myself, which I genuinely wanted to respect even when in the presence of others; that’s, after all, when it really gets tested.

When out with friends, I didn’t want more cocktails, desserts, or fried foods. I didn’t want to leave late to go home to sleep a few miserable hours before getting up to go surf or go to work.

Friends revolted, the family was upset, and I had to get used to sitting at home bored while FOMO-ing over friends. But after a few months of that and I got used to it. Another 5 years or so, and it’s been a habit that’s stuck since.

Despite setting those boundaries, especially here in Spain, my friends still rib me for not staying out late, not going out much, not drinking with them, etc.

Relationships Are Much Better with Boundaries

My friends still give me a hard time, but you know what else? They kinda like it. It’s much easier to deal with a person with semi-firm, healthy boundaries than someone who is all over the place.

I discovered as much for myself; my friends, who are predictable in certain actions, are a bedrock in my social circles.

In my romantic relationship, I understand what I need and when I need it. Often this need will clash with my partner’s needs. But when I can address my own needs, I’m a better partner, which is obvious to her – it’s really a win-win for both of us.

Being Selfish is an Asset

I became militantly selfish somewhere around 2014. When I didn’t feel like doing something, I didn’t do it. If someone wanted to force me into something, I’d speak up.

It became ‘me first’ and then ‘you.’ But never at the expense of another person – never taking away someone else’s right for my sake. That’s not being selfish. That’s being evil.

Whenever I make plans with someone, I tell them that I may need to cancel last minute. Most people don’t register this because it’s a sin to cancel plans. I’m a happy flake and, in fact, my friends have a phrase for it:

You’re gonna pull a Mo?!

Indeed. And the same people who have used that phrase pull Mo’s all the time now. They’ve even told me how great it feels to not have to stick to a commitment. I mean, really, we’re not saving the world here; we’re meeting up for coffee or a drink.

Boundaries When Dealing with Parents

The boundaries I’ve set with my parents are rather disagreeable to those around me. They comment that it’s a harsh stance to take … followed by:

I wish I could do what you do but obviosuly I can’t and don’t want to.

What works for me certainly won’t work for someone else. But I love the relationship I have with my sister, my dad, and my mom. It’s a more distant one; the conversations are shorter, I share less about myself, but I feel love for them now because of these boundaries.

Before, I thought of them as annoying, intrusive, and manipulative. Now, I look forward to our conversations which only happen a few times a year, admittedly. And we see each other perhaps a couple of times a year.

Boundaries Dealing with Service People

Now in my mid-forties, I’ve had a few run-ins with my own doctors. I’ve dealt with contractors, mechanics, and attorneys.

In the past, I would get angry, frustrated, harbor resentment, get passive-aggressive, and it all would turn into a shitball and spiral out of control.

Now, I feel that I have more options. I communicate my needs, and allow the other person to have their own needs and boundaries, and perhaps because I feel more secure in my stance, I’m able to communicate from a place of calm. Not fear, not anger, just calm.

Everything eventually gets solved. All problems eventually disappear. The best way I know how to get through this life with less suffering is by acknowledging my fears, and thoughts and setting healthy boundaries to interact with the world.

Boundaries in My Medical Practice

I won’t discuss this, actually. I am going to leave this for another article. But if you’ve read up to now, maybe think about how you would set healthy boundariesr in your medical practice when interacting with patients, colleagues, and bosses.

I had to pay $3k for a course on Professional Boundaries – I totally forgot about that. I think that was a good thing for me.

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