Many years ago, our family rescue dog’s health began to decline quickly. He was around thirteen years old at the time, so we knew the end was coming soon. If you’ve ever experienced an aging pet, you know how extremely difficult it is to make the decision to say goodbye. To add to the difficulty, I felt like I was making the decision alone since my divorce. I had a wonderful family and friends to help and validate my experience, but no one else (except my daughter, who was only eight at the time) had lived with him all the time and witnessed his day-to-day decline the way I did. Luckily, my vet was amazing and fully supported my decision to let him go. We scheduled the appointment for that Friday.
It was a Wednesday. I’ll never forget taking the call from my vet while standing next to my executive assistant. She knew what was going on and what I had been struggling with over the past few weeks. As soon as I hung up the phone, I went numb. I couldn’t think straight. I knew I wouldn’t be able to function at work. I told her, “I need to go home right now. I’ll be back at work on Monday.” My executive assistant was incredible and said, “I’ll make it happen. Go take care of you and your pup.” I was able to spend the next few days snuggling with my dog and cherishing my last bit of time with him. It was one of the greatest gifts I ever gave myself.
I wasn’t used to asking for what I needed. I wasn’t used to even allowing myself to have needs, let alone express them. As difficult as it was to assert myself in that moment, it was necessary for my well-being. I would have regretted not spending those last few days with my dog and allowing myself to step into how incredibly difficult that week was for me. Looking back, I also realize that I was so numb and shell-shocked by my conversation with the vet that it almost didn’t matter to me how anyone else reacted to my decision to take the next few days off. I wouldn’t have been able to absorb or react to anyone else’s behavior or emotions at that moment.
This encounter was one of the first examples of setting a boundary in my adult life. If you’re not familiar with setting boundaries for yourself, it can initially feel selfish and off-putting.
The boundaries I’m referring to are not physical ones. One of my favorite internet memes at the beginning of the COVID pandemic was, “When all of this is over, I still want some of you to stay six feet away from me.” Maybe that describes you (non-huggers, rejoice!). I’m specifically referring to protecting our time, energy, and emotional health.
When our boundaries are violated, we may feel hurt, betrayed, or angry—or a combination of all three. We may not even know our boundaries until they are crossed.
During a coaching session, one of my physician clients shared that she wanted to start attending a weekly Pilates class. The class was on Saturday mornings, and she told me her family expressed support for her attending. However, she was worried because she normally spent Saturday mornings catching up on charts. If she went to the class, she feared having to move her charting to a different time during the weekend, time that she would have spent with her family. She told me, “I know I am supposed to be setting a boundary, but I really can’t.” As she thought about setting this boundary, I asked her what feelings came up. She said she was afraid her family would perceive her as selfish, as failing to contribute to the family, and that she would be letting her family down. She shared with me that she thought setting a boundary was equivalent to telling her work colleagues, “That’s not my job,” since she saw this behavior modeled in her clinic staff. She bristled at the idea of setting boundaries at first because she felt it went against one of her core values of teamwork.
Psychologist Dr. Becky Kennedy defines a boundary in this way: “A boundary is something you tell someone you will do, and it requires the other person to do nothing.”
This is the most empowering definition and description of a boundary that I’ve encountered. In my example, I told my team that I would take the rest of the week off due to a family emergency. My boundary required them to do nothing. This was different from making a request, which may have been asking a colleague to do something in my absence. I didn’t have to do that in this situation. What I love about Dr. Kennedy’s definition is that it allows us to take complete control. Because we are not asking anyone to do anything, we don’t have to depend on someone else’s behavior in order to set the boundary. We don’t have to wait for someone to act for the boundary to be put into place. We have total control over the boundary because our behavior is the only behavior included in the equation.
Dr. Kennedy’s definition can also release us from the guilt that comes up when we start to set boundaries. Physicians tend to be people who feel they need to do everything themselves. When you were in medical school, you were likely asked to perform tasks for patients that are usually carried out by someone else: starting IVs, taking vital signs, transporting patients, or running down to radiology to retrieve X-rays (if you went to medical school before digital imaging as I did!). These tasks were seen as a necessary part of our training, and we were evaluated based on our ability and willingness to say “yes” to every task asked of us (no matter how menial). We were rewarded for “being a team player” and performing these tasks that we knew were not critical components of our medical education. The thought of saying “no” to the attending or resident who asked us to carry out these tasks (that probably included fetching coffee) likely induced great fear. Chances were high that saying “no” to these tasks would have had dire consequences for our evaluation, our grades, and our future.
We’ve been programmed from an early age to please those around us. As children, we were rewarded with attention and good grades for pleasing our parents and our teachers. These rewards continued in our medical training; when we pleased our residents and attendings, we were more likely to receive strong recommendation letters, competitive rotations or internship programs, or highly sought-after patient cases. Our brains learn that “pleasing others” equals “getting what we want,” and we get a dopamine hit from people-pleasing.
We were hardwired to do things that someone else could have easily done. We may have even scored points on our residency application essay for a phrase such as, “I never ask someone to do something that I can do myself.” These habits may have been encoded in infancy and childhood when people-pleasing was a matter of survival. We depended on our caregivers for our every need, and if they were unhappy with us, the consequences may have been detrimental to our livelihood.
The challenge now is we do not have enough time in the day to do all of the tasks that, yes, we can easily do. Of course, you can room your own patients when your medical assistant is late or running behind. Of course, you can call your patients back with normal lab values. Of course, you can call the hospital to request records. I know you are very capable and good at doing these things! You may even enjoy those tasks on some level.
But…your time is limited. Performing tasks that someone else could do—and that are more aligned with their role—is not the best use of your time. Your energy is also finite, and we can quickly deplete our energy by spending time on tasks that are better suited for someone else. The frustration that comes from doing these tasks further saps our energy.
The danger of people-pleasing
If you always make yourself available when someone needs you, you will feel depleted rather quickly. You may have heard the phrase, “‘No’ is a complete sentence.” It takes energy and courage to say “no” when honoring the requests of others is not in our best interests. However, saying “no” is absolutely necessary to maintain balance in our lives. We cannot be everything to everyone, and we cannot honor every request that is made of us. We may fear that the other person on the receiving end of the word “no” will be angry or will reject us. While that may be the case in the short term, in my experience, both in my own life and in the lives of my physician clients, the other person will often respect us for honoring ourselves and asserting our own needs. Over time, the more we ask for what we need and respond in a way that meets our own interests, others will respect the new boundaries we have set. And—even more magical—we set an example for those around us and give others permission to set their own boundaries. This can be so incredibly impactful when we are in a position of influence—parenting, leading a team, caring for patients—where we model the desired behavior and empower others along the way. If you’re reading this, you are absolutely in a position of influence, whether you recognize it or not.
If you’re like most people, at this point, you are starting to ask yourself how your boundaries will affect others. Our lives are so interconnected that it’s next to impossible for an impactful boundary to not impact someone else… and not just anyone, usually someone that’s important to us: our spouse or partner, our children, our close family or friends, our colleagues, our patients. It’s important that we process these emotions and create a plan for any worries that come up.
Here’s a great quote from author and researcher Daniell Koepke on this topic:
What if they get mad at me?
If people get mad at you for having boundaries, it means they’ve benefited from you not having any. You don’t need to keep people happy every minute of the day. You are not responsible for other people’s feelings. If someone has a reaction to your boundary, you didn’t “make” them react. You chose to voice your feelings and needs. They chose their reaction. You cannot control what other people do.
Powerful! I can’t say it any better.
I can’t change what another person does, but I can change how I respond. Otherwise, if I keep waiting for them to stop doing what upsets me, I’m giving away my power.
Other people’s reactions reflect their own boundaries or lack thereof. Living our lives to align with others’ boundaries is a hallmark of people-pleasing behavior. Over time, a focus on pleasing others at the expense of ourselves leads to frustration and burnout. It is impossible to please everyone all the time!
Even if we intellectually know that we can’t please everyone all the time or even that people-pleasing is now actively getting in the way of what we want, it can be incredibly difficult to translate that knowledge into action. Our bodies have learned via the reward system that people-pleasing makes us feel good (thanks, dopamine!). The first step is to recognize and acknowledge that this thought process and behavior hinder us from reaching our goals. Once we acknowledge it, we can practice a different behavior and utilize the skills discussed in managing strong emotions to navigate through the discomfort that will arise. Working with a coach to support and encourage us can be incredibly helpful in this process.
It’s key to have compassion for yourself and to honor the parts of yourself that clung to these beliefs. You may have needed those beliefs to survive or power through a certain time period in your life. One powerful tool is to thank those parts of you who are trying to protect you. It’s not only OK that this process occurs, but it’s necessary, normal, and important. You cannot grow and achieve different results if your thought habits and your behaviors stay the same.
Only you will know what these thoughts and behaviors will be, and yours will probably be different from someone else’s (also OK, necessary, and normal). When you honor your fullest self, you create space and permission for others to do the same, which is the best gift you can give someone.
To reclaim our time and energy—resources that we don’t get back once gone—it’s critical that we identify, set, and maintain the boundaries that align with our well-being and our values. It takes practice and near-constant attention! As you work through this process and practice a new way of thinking, acting, and relating, please be compassionate with yourself. This work can be hard at times, but the rewards are immense.
A couple of years ago, I was coaching a physician client who was a successful, high-achieving, driven primary care physician. One of her passions was volunteering and contributing to her church congregation in different ways. During the session, she shared some frustration that she had made a commitment to a large project at church, yet she didn’t want to be working on it. I asked her why she committed to it, and she said, “Because the priest asked me, and no one else wanted to do it.” Her frustration centered around the fact that the project was due soon, and she said she would have to spend her entire weekend working on it when she was behind on charts and needed to catch up…and somehow also spend time with family and get in some exercise.
I helped her explore the thoughts that led her to volunteer for this particular project. She said she felt obligated because she was asked to do it. She didn’t know how to say “no.” Because she felt obligated, she wasn’t looking forward to it, which only increased her frustration. This project was not meaningful to her, and it was a low priority for her. A difficult situation all around led her to wish she had not said “yes” when asked. She was spending a lot of time and energy on something that didn’t matter much to her and that could have been better spent elsewhere (like with her family … her number one priority!).
She anticipated another similar ask from this priest coming up, something else that she didn’t want to do. Her brain was telling her (that sneaky brain) that if she said no, the priest (with whom she had a strong friendship) wouldn’t respect her and would be mad at her. I helped her question that thought, and during our conversation, she had an insight that the priest, as a friend, would not want her to feel so frustrated and pressured. He wanted her to speak up for herself and say “no” when she needed to. We talked through some strategies to say “no” in a loving and kind way. The one that we crafted together was, “I’m not able to fulfill that request right now.” (Say it with me: “I’m not able to fulfill that request right now.”)
If you want to go for the gold, you can offer someone else who could help them. If you feel a need to justify (but you don’t have to!), then you could tell the other person that you wouldn’t be able to do the project justice. Again, justification is not necessary … remember that “no” is a complete sentence. Once my client established boundaries, she shared with me that she was “less guarded and more relaxed” and that she was sleeping better as a result of the reduced stress.
In one coaching session, a physician assistant client of mine shared his challenge of saying “no” to leading a project that was asked of him since he didn’t have the time or resources. He came away with the phrase, “I’m honored that you came to me. I can see this is very important to you. I don’t think I’m the best person for this.” He felt so empowered with the idea of setting this boundary. Shortly after our conversation, he was promoted to a leadership position—a promotion which, I truly believe, would not have happened had he not established and communicated those boundaries initially.
We waste precious time and energy on other people’s agendas. If we don’t set boundaries for ourselves, we can’t spend our time intentionally. We relinquish power to others to dictate how we spend our time and where we focus. Setting and maintaining boundaries is really the keystone to all of time management; we can’t manage our time effectively unless we do so.
Grab your journal for the following exercise to get into action:
- What’s one boundary you can set this week? It’s OK—and actually a good idea at first—to start with something small! You’ll build confidence by taking small and manageable steps!
- As you think about setting this boundary, what thoughts come up? Write them all down here.
- Are these thoughts true?
- What permission do you need to give yourself to set this boundary?
Taking action on these insights is necessary to cement these concepts. Keep practicing, and it will get easier over time.
Laura Suttin is a family physician.
