You Don't Have to be Like Everyone Else

"Well Dr [insert-your-name here], EVERYONE else usually sees late patients."

"My old doctor ALWAYS gives me a z-pack when I have this."

Etc, etc

My friends, I would like to tell you, here and now, that you don't need to be like everyone else.

I was talking with a client recently, and her story is like many; a primary care clinic with significant staffing shortages; patients calling for same-days, staff asking where to put double-books, "oh, this is "just" a quick thing," etc. And as we talked, we shared stories of how, most of the time, it's not a "just" a quick thing, it's often more involved, more complex than what the patient or said staff member believed.

And we talked through the fact that she could decide, for herself, how she responds with these asks, which come daily, throughout the day, to work people in, stop the space-time continuum and magically take care of all of the things. And we talked about the pressure she receives from patients, staff and management to "just" squeeze them in, and the discomfort of maintaining boundaries around her time. And this was one of the messages she receives, that "everyone else" works them in.

And we decided, perhaps for the first time, that she doesn't have to do this like everyone else. If they are asking, then she can decide, in advance, that she doesn't take double books or late arrivals. And she can tell others, over and over, in response to their inquiries (because they will keep asking), "no, I'm not able to see them and provide safe, quality care."

Period.

The implication in the "everyone else does this" statement, of course, is that you should be like everyone else. But as many of us know, there are reasons why our patients come to US, and not our colleagues. And to preserve the us-ness, whether that is the relationships we have with patients, the time and care we provide, etc, it is ok to decide that we don't do things like everyone else.

We decided to practice some verbal phrases that reflect these boundaries, as well as some standardized text responses, "dot phrases" for my Epic crowd, that state politely, simply and clearly that the answer is "no," and that it is to preserve safety and quality of care.

Is this perfect? No

Is this easy? No, especially at the start

Can there be pressure? Absolutely

Might it be worth it? 100% yes.

When you decide that you have agency to choose how you practice medicine, what is ok and what's not ok, and your reasons come down to safety and quality, you are standing in your integrity, and you are being generous to yourself and to others.

Contrast this with working in all the extra visits, rushing care, feeling overwhelmed, making mistakes, feeling resentful and getting more and more cynical and burned out. 

What do you choose?

TL:DR Boundaries are good, and can be simple; but boundaries are not easy!