Setting and Maintaining Boundaries: Insights from the ACFAS ASC

Podiatry Today had the chance to touch down with Lisa Levick-Doane, DPM, FACFAS, of the Levick Foot and Ankle Institute in Northbrook, IL, about her part of the session on physician wellness at the recent ACFAS Annual Scientific Conference.

In general, what has your experience and observation been as far as the current state of professional boundaries for physicians and surgeons?

The state of professional boundaries for physicians and surgeons can vary depending on the setting, but in general, there's increasing awareness about the importance of maintaining healthy boundaries. Historically, the medical profession has been one where boundaries were sometimes less emphasized, with an expectation of self-sacrifice, especially in high-demand environments like surgery. However, in recent years, there’s been a push to recognize that healthy boundaries are crucial for the well-being of both clinicians and patients. Issues like physician burnout, overwork, and blurred boundaries due to increasing demands have made this a more urgent conversation. The rise of telemedicine, social media, and greater patient access to physicians outside of office hours has further complicated the landscape of professional boundaries, requiring even more attention

Why do you feel that setting and maintaining boundaries is an important skill for clinicians to implement? 

Setting and maintaining boundaries is essential for clinicians because it helps protect their physical and emotional well-being, allowing them to provide better care over the long term. Physicians, particularly surgeons, often face the risk of burnout due to the intense nature of their work. Without clear boundaries, there’s a risk of emotional exhaustion, compassion fatigue, and decreased job satisfaction. Healthy boundaries also support the maintenance of professional integrity, ensuring that clinicians maintain an appropriate level of empathy and care without overextending themselves in ways that could compromise their effectiveness or personal life. It fosters an environment where work-life balance is possible, and clinicians can continue to perform at their best.

What are some of the positive things that can come out of healthy boundary setting and maintenance, and how can this impact physician wellness and patient care?

Clinicians who maintain boundaries are more likely to avoid burnout, maintain their mental health, and preserve their sense of purpose in their work. This translates into better job satisfaction and long-term career sustainability. Healthy boundaries allow physicians to be more present and effective with patients during their interactions. By taking care of their own needs, clinicians are more capable of providing thoughtful, compassionate, and high-quality care. Setting boundaries allows for clear communication and expectations between physicians, patients, and colleagues. This clarity can prevent misunderstandings, reduce conflicts, and create a more collaborative environment.

What is one thing you recommend that surgeons can do today in their practices to improve their efforts towards setting boundaries?

In my opinion, everyone is capable of setting boundaries. The key question is why we don’t do it or do not enforce a boundary. Once we understand the psychology behind the former question, we can tackle boundaries head on. A key recommendation for surgeons is to sit in the discomfort that may arise when setting boundaries. It's natural to feel uneasy about creating limits, especially in a field where there's often an ingrained sense of duty to be constantly available and accommodating. However, recognizing that setting boundaries is ultimately a form of self-respect and a commitment to providing the best care is crucial. Surgeons can start by acknowledging the discomfort that comes with saying “no” or limiting availability and then gradually building the confidence to maintain those boundaries. Over time, this practice will help create a healthier work-life balance, reduce stress, and improve overall patient care, as surgeons will be able to give their best without feeling overwhelmed.

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