The Power of No: Physician Boundaries Without Guilt in Medicine  | Ep25

Michael Hersh, MD

[00:00:00] 

It doesn't happen all at once. Late-night charting, the quick call you agreed to cover the meeting you didn't quite have time for, but said yes to anyway. One small compromise at a time until your day isn't really yours anymore. You see a message come through at 9:00 PM and before you even think your thumb's already typing, sure, no problem.

You're tired. You're stretched thin, but saying no still feels harder than saying yes. And if you're like most physicians, you've learned to call that dedication. But what if it's actually avoidance? Avoiding the guilt, avoiding the disappointment. Avoiding the discomfort of letting someone down. Today we are talking about boundaries, not as walls, to keep people out, but as lines in the sand that protect your time, [00:01:00] your energy, and your integrity stick around because learning to hold boundaries might be one of the most important skills you ever build.

Well, hey everyone, and welcome back to the Better Physician Life Podcast. So today we are talking about boundaries. One of the most misunderstood skills in medicine, because let's be honest, most of us were never taught how to have them. We were taught to be available and helpful, reliable.

To say yes and fix things, to put everyone else's needs before our own. And for a while that works. It helps us build a career, a reputation, and even a sense of pride. Until one day you realize you're running on fumes and there's nothing left for you, and the people you love are getting [00:02:00] what's left of you.

Not the best of you. The truth is boundaries. Don't just protect your time. They protect your ability to be fully present for the people and the activities that you love. They don't just keep the bad out. They keep the good in. So in this episode, we're gonna talk about why saying no feels so uncomfortable for doctors.

And what healthy boundaries actually look like, both at work and at home. and how learning to hold boundaries can actually make you a better doctor, a better leader, and a better partner. Alright, ready to dive in. Let's get into it. So we are gonna start with the part that no one wants to admit.

That most of us don't actually have a problem saying, yes, we've built entire [00:03:00] careers on it. Extra patient? Yes. Join that new committee. Okay. Cover an extra call. Sure. Why not? Late-night meeting. That benefits the whole group. Fine. Early on that yes works for you. It builds trust. It proves you're dependable.

It opens doors and opportunities, but over time, that same yes, starts to take more than it gives. You start to feel trapped by your own reliability, and yet saying no still feels impossible. Why? Because for most physicians saying no, doesn't just feel like declining a request. It feels like disappointing someone and disappointment hits us where it hurts our identity.

From the first days of our medical training, our worth has been measured by performance, by how [00:04:00] much we can handle, by how many people we can help. By how much we can accomplish. Medicine trains us to equate endurance. Excellence. So every time we say no, it can feel like we're letting someone down. Our team, our patients, our families, even ourselves.

We start to believe that if someone's upset, we did something wrong. But here's the truth, and it's one, most of us were never taught. You can do everything right and someone will still be unhappy. You can show up, you can care deeply. You can give your best and still face frustration, disappointment, or even anger from someone else, and that's not a sign you failed.

That's a sign you're human because boundaries don't control how other people feel. [00:05:00] They define how you'll show up even when someone else is uncomfortable. And that's where the shift begins. The moment you realize that other people's reactions aren't your responsibility, that's when you start to take your life back.

So let's talk about what healthy boundaries really are, and maybe more importantly, what they're not. Because when most people hear the word boundary, they picture a wall. Distance. Rejection. But that's not it at all. Boundaries aren't about control or punishment. They're about ownership. They define what's okay for you and maybe more importantly what's not.

And the simplest way to think about them is as an if-then statement. If you raise your voice, then I'll step away. If you text [00:06:00] me about work after hours, I'll respond in the morning. If you try to add a patient to my schedule when it's already full, I'll decline or I'll reschedule to protect the rest of my day.

Boundaries aren't about changing other people. They're about deciding how you'll respond when they don't change. That's what makes them powerful, but it's also what makes them difficult. Because when you set a boundary, you have to be willing to follow through, to let people feel what they're gonna feel, and to let them be wrong about you.

That's the part no one likes to talk about, that boundaries don't always make people happy, and they're not supposed to. Boundaries aren't meant to make things comfortable. They're meant to make things clear. They say, this is how I take care of myself so I can keep showing up for you. [00:07:00] And that's what changes everything because the goal isn't to control other people.

It's to stay in integrity with yourself and to stay true to what actually matters. And here's where it gets tricky, even when we know what matters. Saying no can feel impossible. For most physicians, the word no comes with a story. I'll disappoint them. They'll think I'm not a team player. I'll miss out on something important.

And under all of that sits a question we know all too well. If I say no, what will they think about me? And right behind that, the one that cuts even deeper, the one we're often not even aware of. If I say no. What does that mean about me? Because medicine taught us to define our worth by how much we give, how much we do, how much we handle, and how much we say yes.

So [00:08:00] when we say no, it can feel like we're letting people down, like we're letting ourselves down, but people are gonna feel how they're gonna feel and you can't control that. Again, you can do everything right and someone will still be upset. You can go above and beyond, and someone will still want more.

Boundaries don't change that. They just bring honesty back into the mix. They make you tell yourself the truth because when you say yes to something you really don't want to do, you don't escape saying no. It's just the person you're actually saying no to is you. And that's the part most of us never notice. That every yes already contains a no.

The only question is who you're saying no to. That's where the shift happens. Saying no isn't a rejection, it's a redirection. It's how you protect your [00:09:00] time, your energy, and your integrity. So when you do say yes, it actually means something. Every decision costs something. When you say yes to one thing, you're automatically saying no to something else.

That's the reality of it. And the sooner we stop fighting it, the clearer things get and the more control we regain, because the idea that we can do it all, that we should do it all. Is the lie that keeps most of us completely exhausted. You're always going to be missing out on something.

The question isn't whether you'll miss out. It's what are you willing to miss out on? When you start seeing your yeses and nos as choices instead of obligations, you take back control of your life. You start running your schedule instead of letting your schedule run you. And you start deciding what to give your time, your energy, and your [00:10:00] attention to not out of guilt, but out of intention.

And the more honest you get about what you're actually saying no to, the more meaningful your yeses become because now you're saying yes on purpose to the people, to the work, and to the moments that actually matter. Because every time you honor a boundary, you reinforce the belief that your word matters even to yourself.

And that's where real integrity starts. It's where things finally start to make sense. Boundaries are how you live in line with your values, not just your habits. They're how you make sure your life actually reflects what you say matters most. Boundaries don't push people away. They actually create the conditions for real connection because when you are clear about what's okay and what's not, [00:11:00] people learn.

They can trust what you say. They know where you stand, they know what to expect from you, and that kind of consistency builds safety. Whether you're working with a colleague, leading a team, or showing up at home. Think about it. The people you respect most aren't the ones who say yes to everything.

They're the ones whose word means something. The same thing applies to you when you set a boundary and keep it. You're not just managing your time, you're modeling self-respect, and that gives other people permission to do the same thing. The truth is the people who belong in your life won't be threatened by your boundaries.

They'll be grateful for them At work, boundaries will build respect. At home, they build trust. They keep resentment from quietly building in the background, and they make [00:12:00] space for the kind of honesty that keeps relationships strong. So if you've ever thought boundaries were about control or disconnection, here's the reframe.

Boundaries are how you stay close without losing yourself. So here's a question for you. Where in your life could one boundary make things easier or simpler? Maybe it's at work, saying no to the extra meeting or the quick curbside consult, or the patient squeeze-in that always runs over. Maybe it's at home, setting aside one uninterrupted hour with your family or deciding to stop checking messages after dinner.

Whatever it is. Remember this, boundaries aren't about restriction. They're about direction. They're about showing up as the best version of yourself, even when things get tough. Especially [00:13:00] when things get tough. They give your yeses more weight and give you more control over your time because when you stop giving your time away by default, you start running your schedule instead of letting your schedule run you.

And that is the key to a better physician life. And one of the best places to start setting that kind of boundary is right at the line between work and home. Because if you're like most physicians, you don't just walk through the door. At the end of the day, you're still stuck in work mode carrying the day with you, running the patient lists, thinking about the in baskets, worrying about tomorrow's schedule.

You're finally home, but your day is still running in the background. That transition from doctor mode to home mode doesn't happen automatically. It takes intention. And that's why I created the 5-Minute Commute Reset for Physicians. It's a short guided audio [00:14:00] and an optional worksheet to help you process the day, leave work at work, and walk through the door ready, connect with the people and the priorities that matter most, and you can download it for free at betterphysicianlife.com/commutereset, and I'll link it in the show notes

Because presence, just like boundaries, doesn't happen by accident. It happens by choice. So what are you choosing? Thank you again so much for being here today, and I will see you next time on the Better Physician Life Podcast.