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Specific Ways Doctors Can Create Boundaries This Week with Victoria Silas MD

by Coach Jill Farmer, Physician Coaching, Physician Wellness, Podcast, Resilience, Work Life Balance

In this episode you will learn about specific ways doctors can create boundaries this week.

“Boundaries really are an act of compassion for yourself and for other people. And that’s what we really need to help doctors understand.” Victoria Silas MD

In today’s episode, DocWorking top coaches scrub in on the topic of Boundary Setting. Master Certified Coach Jill Farmer talks with board certified Orthopedic Surgeon and Certified Coach Victoria Silas about specific ways that doctors can create boundaries this week. Victoria shares how she has implemented specific boundaries in her professional life in order to keep her personal life separate. You will hear the boundaries she uses as well as reasons to allow yourself to create boundaries without feeling like you are being mean. Because boundaries are a way for us to communicate our needs clearly. And when we use clear boundaries we can avoid feelings of resentment towards those who don’t automatically know our needs. We would love to hear what boundaries you are going to implement after listening to this episode! Reach out to us on Facebook, Instagram or Twitter to share. 

You can find Certified Coach Victoria Silas MD as one of the top coaches in DocWorking THRIVE, and a link to schedule one on one sessions with her in DocWorking Coaches and Courses, or at www.medicalmindsconsulting.comShe is a board-certified Orthopedic Surgeon and certified coach with 21 years experience in practicing medicine and 10 years experience in coaching. Now retired from medicine, Victoria helps other physicians cultivate a sense of calm and control in their personal and professional lives, as they regain their love for medicine and rekindle their sense of purpose and professional excitement. 

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Podcast produced by: Amanda Taran

Please enjoy the full transcript below

Victoria: Boundaries really are an act of compassion for yourself and for other people. And that’s what we really need to help doctors understand.

 

[DocWorking Podcast theme]

 

Jill: Hello, everyone, and welcome to DocWorking: The Whole Physician Podcast. We are so thrilled you’re here and I’m really excited for today’s topic, because we’re talking about something that a lot of physicians know, they’d like to get better at, boundaries, but a lot of times physician clients will say, “Okay, I’m supposed to get better at boundaries but how exactly do I do that and what are some examples of that?” So, I brought in one of the experts. She is a colleague, a fellow coach, and also, she’s a board certified Pediatric Orthopedic Surgeon, she’s had all kinds of leadership positions throughout her career and now she owns a company called Medical Minds Consulting, where she helps coach physicians to their best life.

 

She’s also one of the leaders in our THRIVE community for physicians and helps manage our online community there. So, Victoria, you and I’ve talked about this in online conversations before, and I just think it’s so helpful for our physician listeners to get some more details about how the heck they create better boundaries. So, I love some of the ways that you did that during the years that you were practicing full time. What did you find was one of the best things that you did that made a difference in terms of helping you have a boundary that was needed?

 

Victoria: Thanks, Jill. I’m thrilled to be here. Thanks for having me. Well, first, what I’d like to say is that boundaries need reinforcements. Just like with a toddler, you have to keep setting that boundary when it keeps being violated or no one will respect it. Sometimes, it’s hard because you can feel like you’re being mean by setting a boundary. You can get feedback that you’re difficult because you set a boundary like, “My staff used to think I was difficult, my partner was easy, because they could shove anybody into his clinic, and he would never complain.” I was very adamant about keeping to the boundaries that I’d set in clinic for the number of patients and the kind of appointments that they needed to have. So, that’s one way that I set and reinforced boundaries.

 

Another way was, when I was first in practice, when I had time off, whether it was the weekend off or vacations off, I would frequently get emails, I’d get pages, I’d get phone calls, and so, what I eventually learned to do was to set an out of office email, so that people would be aware I wasn’t available, and I would set an out of office announcement in the EMR with who is covering for me this weekend or this week while I’m away. So, it was very clear that I was not going to be available during those times. 

 

Jill: I love that. My husband is not a physician but he is a very busy lawyer. He, for the longest time, would not do out of office emails when he was there because he was like, “Well, I’ll just get to the emails in the evening or when we’re not doing our vacation things.” I think it was an administrative assistant that gave him the feedback that it was confusing when somebody needed something really important from him, and then, email him, and wonder why they weren’t hearing back, like, his normal response time, and that it was just much more clarifying for him to have that out of office response. Because they knew, “Oh, we need to look for that answer from somebody else.” And so, that changed his pattern of behavior, helped him relax a lot more when he was not working. I think it was really helpful for those in the workforce where he was as well. 

 

I think that’s something that’s really important. Some people are hesitant to do boundaries because they feel like it’s kind of aggressively dividing themselves or they feel like it’s kind of a battle thing, “I’m protecting myself from somebody else’s assault.” I always like to say, boundaries don’t have to be brick walls, unless they need to be for safety and other reasons. 

 

Victoria: [laughs] 

 

Jill: But a lot of the time, boundaries can be more like those white picket fences we see in Kentucky when you go look at the horses, and it’s very clear what’s your land and what is not your land and it’s clarified by a clear boundary. So, boundaries are not meant to divide as much as they are to clarify. So, I love both of those practices. I think those are really good ideas.

 

Victoria: I think that’s a really great point and I think a lot of times physicians feel like they’re being a not nice by putting up these boundaries and that they really should be available at all times to everybody who needs them. I understand that impulse. But the fact of the matter is, when I set those boundaries in the EMR or in the email, my partners still knew how to get in touch with me. So, if there really was some kind of question that was important, and they couldn’t answer. It wasn’t that no one could reach me, it was that I made it a little more challenging, so that only the really important stuff that needed to come to me would come to me. 

 

Another way that I did this was, I had a separate phone, that was my work phone. And yes, it cost a little bit more money but it just allowed a little bit more of that separation, where my partners had my real phone number, but the clinic staff, the emergency department, the hospital offices, they have the work phone. So, that allowed me when I went on vacation to leave the work phone at home. Again, I have my personal phone with me, people can absolutely reach me if it’s an emergency, but I just made it a little bit harder by having that boundary. And then, on weekends when I was off, same thing. That work phone stays in the car. I’m still available on the personal phone but there’s a separation. 

 

The other thing that that does is, I know for a lot of physicians, “Okay, you’re off. The ER knows you’re off and yet, you’re getting a phone call.” So, there’s this terrible guilt feeling if you don’t answer it. Well, if the phone is in the car, I can’t hear it. I don’t know that it’s happening. So, I can go about my life. Again, if someone really needs to get in touch with me, that is still available.

 

Jill: Yeah, that’s perfect, because that’s often what I hear from people is that, if you don’t put things in place like what you’ve talked about, then, it requires superhuman resolve on your part to ignore it or to not have an emotional response to the fact that somebody is trying to get there, then, I think it’s just a good reminder for you that you need to take a step to just make that boundary clearer for your own peace of mind as well. I had an example that came up with a physician client recently that will probably sound familiar to you as well, but a surgeon, and he is also kind of a balance between clinical and research work. During the time when he’s working on research, his ideal time to work is at night like 11 PM to 2 AM was when a lot of the good stuff happened. So, the next morning, a lot of times after he would do that work, there was just a pattern where the overnight fellow resident would check in at like 6 AM, not because of an emergency, but just to update him, because that’s when they had the time to do it. 

 

The previous person in that position was a very early riser and liked to hear that information as he was finishing his workout. So, it was a little uncomfortable to have the conversation to say, “Is there any chance you can call me at 7:30 AM or 8 AM instead of 6 AM?” Everybody was like, “Yeah, no problem.” It was just moving the boundary to a place that worked much better for the physical and emotional health of the surgeon to not have that sort of unnecessary sleep interruption. Of course, if there were more pertinent questions that needed to be asked, very much was used to having his sleep disturbed. But when it was just like, “Oh, I’m just checking in,” it was like, “Does this really have to happen at this time of the day?”

 

Victoria: [laughs] Yeah, I think that’s often the question for physicians, “Does this really have to happen right now?” And I love the way he set up that boundary for two reasons. One, it made the situation work better for him, but the other thing he’s doing is, he’s modeling for fellows and students, that it is okay to change what’s always been done so that it serves you better, so that you can be more effective in the work that you do and how you need to organize your life. The other thing it reminds me of is, we’ve spoken very frequently about taking a pause between a stimulus that comes in. And you take a pause so that you can respond rather than react. I think boundaries help us do that. 

 

Another way that I set a boundary of sorts is, I had this one colleague who, whenever he was on a call, he would always call me. Usually, he wasn’t calling me for advice. He wanted me to come save him from whatever it was he was dealing with. What I did with him is, I put his name into my phone as ‘don’t’ and his last name. So that when he would call instead of automatically answering it, I would take a pause like, “Am I able to be available as my best self-right now or do I need to let this just go to voicemail, and then, check to see what the problem is?” If it’s really critical, he definitely needs help. “Okay, I’ll jump in and take care of it.” But if it’s not really critical, it’s one of those things he can take care of, but he’s kind of being a little bit less than helpful about it, then, it gives me that opportunity to, again, have a pause in there. So, I’m not leaving, being out to dinner with friends to go into the emergency room when I’m not on call.

 

Jill: Yeah, that’s excellent. Because that’s part of the problem without having boundaries is then we become that exploding doormat, right? In this case, this person had a pattern of behavior where it’s going to make people irritated. But in other cases, we don’t have good boundaries with one subset of people. Then, often those closest to us like our good friends, colleagues, and family members that it’s safe to be our full emotional spectrum with, they’ll just ask an innocent question or, call us, or text us, and then, they get this kind of overreaction or triggered response, because we’re irritated that somebody else has not left us alone or is somehow crossing a boundary that we may have not articulated. So, I think that’s a really good example of why having a boundary and helping us to be in that space where we’re self-actualized, where we’re present in the moment and less likely to be reactive or dysregulated emotionally, we’re likely to have a better experience with those communications and encounters that we have.

 

Victoria: Yeah, that’s exactly right. In order to show up as our best selves, boundaries actually really help us. They’re not an example where we’re being mean or even particularly stern and it’s also not an example where you’re trying to create problems with the other person. What you don’t want is to be exhausted, frustrated, and resentful. As you said, take it out on the people who are closest to you are even taking it out on the people that you work with, who are in fact causing the frustration, but it’s because you haven’t been clear about where your boundary is and what your needs are.

 

Jill: Yeah, absolutely, beautifully said and I think that’s really important. I’ve been doing some research on resilience, and some new emerging information, and ideas, and concepts, and data around the idea of resilience, and it turns out, people who have good boundaries tend to be more resilient. The theory behind that is that, if you are someone who doesn’t tend to have good boundaries and tends to just wish that other people would do things differently than they do, and you just think if you try hard enough and are an A+ enough student, that they’ll see how great you are, and then suddenly, they will anticipate your needs and decide that they should create some boundaries, or not overwork you, or ask you to do things. 

 

So, when that doesn’t happen because it hasn’t been communicated, it starts to make people feel like they’ve lost control. Like, “I have no agency in my life. I have no control, even though I’m doing really good work and I’m a great human being, they just keep overworking me, they just keep scheduling me.” At some point, resentment starts to build, and that is burdensome, and that contributes to burnout and to overwhelm. So, to understand– oh, for my long-term ability to answer this calling as a physician to do really great work and serve in the world, boundaries help me do that more, because it helps me to not feel so overwhelmed and to hold on to some of that agency. 

 

Victoria: Yeah, I think that’s absolutely true. Boundaries really are an act of compassion for yourself and for other people and that’s what we really need to help doctors understand. 

 

Jill: So much great information. I hope you guys bookmark this one and come back and listen to it when you find yourself feeling overwhelmed or like there aren’t clear boundaries. Dr. Victoria Silas, surgeon, coach, who gave us so many good examples. Get an additional phone just for work if you find that that’s a source where there’s just way too much contamination of your time and people are encroaching upon things that you need to keep separate. Use those out of office emails and on EMR to make sure there’s clarity about when you’re available and when you’re not. So many other just great suggestions in this conversation. So, I really appreciate you taking the time to talk with us about it.

 

Victoria: Well, it’s been my pleasure to talk with you as always.

 

Jill: Victoria and myself are around having these kinds of conversations with physicians just like you all the time in our DocWorking THRIVE physician community, where she and I help facilitate group coaching, we have online community connections, we have courses with great information on leadership and communication. So, we really hope that you’ll go to docworking.com and check out our Thrive community. As always, it is great that you guys are with us here today and we look forward to seeing you next time on DocWorking: The Whole Physician Podcast.

 

[music]

 

Jen: As a busy physician, you’re managing a lot. A lot of people depend on you. Your patients, your colleagues and staff, your family to get up every day and do all of the things that you do is an accomplishment. But when is the last time you stopped and thought about, “Where am I going with this? What would I like to see for myself in one year, in five years, in 10 years?” What if you had a group of experienced coaches and a community of physicians there to support you, to help you figure out what matters to you, not just at this point in your life, but going forward this year, next year indefinitely? What if you had that support to help you find a way to integrate what matters to you in your career with what matters to you outside of work?

Amanda: I’m Amanda Taran, producer of DocWorking: The Whole Physician Podcast. Thank you for being here. Please check us out at docworking.com and please don’t forget to like and subscribe. Thank you for listening.

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