I first heard this expression as a resident, being ‘encouraged’ by my fellow house staff to limit the number of admissions that came onto the ward while I was on call. I often say it to my office staff now, as my schedule fills up with all manner of patient concerns. But how often do I apply to myself, when yet another responsibility lands on my lap or yet another person makes demands on my personal time? 

It’s a little ironic, considering that, as pediatricians, limit setting is part of our mantra on discipline guidance for parents. From toddlers in time-out to house rules for teenagers, we work with families to develop rules and stick to them. We support them through those difficult times when it seems like that child plans to test every scrap of their parental resolve. We struggle, however, with placing limits on those same families when they ask for another quick conversation on the phone or another form you ‘just have to sign.’

Setting Boundaries | Women in Peds

Dealing with our colleagues and staff can be even more challenging. The people I refer to as ‘my little chickens’ (when I’m not calling them chicken heads) can be my staunchest protectors when it comes to setting those boundary lines between me and my patients. They can also be the worst offenders when they take advantage of my desire to keep the practice running smoothly. The dirty little secret of leadership: sometimes it all comes down to you.

My quick Google search revealed more than 250 million references to the subject of ‘setting boundaries at work.’ Sources from the reputable (Harvard Business Review) to the debatable (Criminal Watchdog?) provide us with the psychology behind this challenge and the strategies for overcoming it. These articles all share the same core message: decide what your boundaries are, how you are going to communicate them, and how you are going to follow through on maintaining them.

In Harvard Business Review, psychologist and podcaster Joe Sanok describes boundaries as our power. “Boundaries allow us to decide when, how, and if we give this power away,” says Sanok, the visionary behind “The Practice of the Practice,” which provides resources for starting and growing a private practice. He believes that we avoid setting boundaries because they force us to confront toxic behavior patterns and address negative internal dialogues that may have roots deep within our psychological framework.

Boundaries | Women in Peds

A recent Indeed article defines boundaries as physical, emotional, and mental. Physical boundaries define how people enter and interact in your personal space. Emotional and mental boundaries are similar, but each has nuances related to how you let other people’s feelings affect you and how you protect your mental health in your interactions. I find that physical boundaries can help me set my mental and emotional boundaries more easily.

For example, do you have the pleasure of your own office within the office? Something as simple as closing the door sets up a physical boundary that allows you the mental space to focus on your own needs at that moment. Will people knock on your door constantly while it’s closed? Of course! Though there may be times when you are not doing something that can’t be interrupted, enforcing the boundary will keep both you and them accountable to what a closed door means.

If you don’t have your own office, find a space where you can go to decompress. Your car can serve this purpose if it’s your only choice. Worst case: a bathroom or storage space. None of these might be places where you stay for an extended period, but they put a physical boundary between you and the outside world. Don’t forget to bring your cellphone (with notifications silenced).

Block out the noise | Women in Peds

Another effective physical boundary: earplugs. Pediatric offices can be loud and chaotic places, even for a solo practitioner (which I am not). Even with my office door closed, I can still hear everything. Aging brains have difficulty focusing with background noise, so we lose our ability to do homework in front of the television like in high school. Earplugs help me tune into my own tasks and thereby decrease my frustration with the people around me.

The Indeed article provides sixteen ways that you can set boundaries at work, but the top three are: prioritize, delegate, and communicate. Once you define what is important to you, then you can create strategies to make sure others know your limits. As they say, practice saying ‘no’ and be prepared for confrontations. If you haven’t set routine boundaries before, it might be a challenging transition but nonetheless very worthwhile.

Blog written by Kimberly Clare, MD MMM FAAP