More About Setting Limits and Saying 'No'
Including answers to FAQs
The Reality of Having Limits
Many physicians struggle with the reality of having limits. It runs counter to conditioning experienced in medical school and residency training. Medical culture and physicians themselves create pressure that pushes them to behave in seemingly super-human ways that ignore limits. This pattern has been reinforced in our society and has guided patient expectations.
Not only do physicians have limits, but so does the health care system. This is a tough reality and is leading many to feel guilty once they finally do learn to say 'no'. Who will pick up the slack?
Initially, many of us thought we could work around the clock to help the pandemic effort and "flatten the curve". We anticipated a relatively quick recovery. Saying 'yes' to overtime and increased workloads made sense and matched our values. Taking on new roles or expanded job descriptions also had a clear purpose. The changes we made were expected to be brief and temporary. Our efforts indeed helped many patients, although it still never seemed to be enough.
As physicians and caregivers, some of us are used to giving, helping, sacrificing, and supporting whenever we sense a need. The constant giving might persist despite exhaustion and physical symptoms. Many doctors ignore their bodies' needs for food, water, and sleep. In a short-term crisis, this sacrifice and effort can be highly valuable for society. Now, almost two years later, we recognize that the increased needs and backlog created by the pandemic are ongoing. Statistics confirm that most physicians are experiencing burnout. If doctors don't learn to respect their limits, this situation will only worsen.
As a society, we can work together and respond effectively and caringly to the global issues Covid-19 has created. This doesn't mean it will be easy, or that our response efforts will be perfect.
We will all need to collaborate respectfully in order to create sustainable plans that address needs and respect limits. Health care administrators and doctors can work together to find approaches that are sensitive to the pain and suffering of workers, patients, and society. If we can reduce rates of burnout in health care workers, we can return to the ideal of providing compassionate care, even when we can't cure or solve everything.
What To Do About Guilt
When it comes to communicating limits, guilt is often the stopper. Guilt may block you from saying 'no', or may linger after communicating your boundaries. This can occur even if your words were respectful and effective.
In the video, I explain that guilt is not all bad. You can learn to understand and have compassion for your own experience of guilt, "dial it down" a little and then use your awareness of guilt as helpful information to guide wise decisions.
Old conditioning can be very powerful and can lead to intense feelings of guilt. If you have been conditioned to feel deeply guilty for saying 'no' you might experience overwhelming challenges with setting healthy boundaries. Some individuals may start to notice that their very identity has become tied to being the one who always says 'yes'. If deeper issues are getting in the way of communicating your limits, you might benefit from personalized coaching or therapy.
The good news is that when you use mutually respectful communication and effective negotiation skills it will become much easier to communicate your limits. With some practice, you will learn to anticipate common pitfalls and reduce the likelihood of negative responses from others. As your skill improves, you may notice that while others don't love to hear your limits, they will respect them. If you learn to offer alternatives and help find meaningful solutions, you will gain even more respect.
Once you learn to work with both healthy and maladaptive guilt (see video) it will no longer prevent you from expressing your truthful limits.
But What About The Demands?
No matter how much work demands increase, this does not change your capacity and limits. This message may be difficult to hear for physicians who feel pressured to meet the never-ending and escalating demands related to the pandemic.
You may be able to work harder, longer, or faster for a short time, but this is not sustainable and can lead to serious adverse outcomes. More health care workers than ever are experiencing symptoms of burnout and this is further decreasing their capacity to work and cope. To keep our health care system afloat and to adapt to changing needs, we are going to need creative solutions. It will help if we come to accept certain limitations and manage human resources realistically. Successful strategies will require sustainable solutions that match healthy human work capacity. As far as we have come, this pandemic is not over.
System-Level Issues Related to Burnout
Fortunately, there are many evidence-informed strategies to help address system-level issues contributing to burnout. The fact that most physicians are experiencing burnout indicates that system-level responses are needed. I will share more about these strategies next month.
For now, as an individual, you can learn to work smarter rather than harder. When possible streamline processes, adjust expectations to be more realistic, reduce repetitive or unnecessary steps, and change what you do to be more efficient or impactful. Since the pandemic hit, I have helped more physicians than ever by introducing more group work. Solutions that have added capacity and impact include providing peer support, teaching, engaging in public speaking, developing courses, and producing videos. However, even as I have been creative in finding ways to meet increased demands, I have also had to say 'no' to many things. I also need to be ever cautious about respecting my own healthy limits. If we each use our strengths to do what we can to help, it will go a long way. We just can't do everything all the time.
-Marcia
