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ER Goddess

ER Goddess

Be Your Own Hero: Say ‘No’ and Set Boundaries

Simons, Sandra Scott MD

doi: 10.1097/01.EEM.0000743216.43097.84
    boundaries, mental health, COVID-19 pandemic

    If policymakers and the public grasped how grueling it has become for health care workers, things would change—or so I told myself. My naïve assumption before the pandemic was that no one knew how much physicians struggle with mental health. Now, stories about our struggles on the COVID-19 front line are reported by every news outlet.

    Recently, a headline in the New York Times read, “A Parallel Pandemic Hits Health Care Workers: Trauma and Exhaustion.” (Feb. 4, 2021; Everyone understands we're overwhelmed, but things don't seem to be changing.

    If publicity from the pandemic hasn't changed things, what will? As we endure moral injury despite the spotlight on our turmoil, I realized we can't wait passively for things to change. It's up to us to protect our own mental health proactively. How? Boundaries.

    Setting boundaries and saying “no” is one of the healthiest ways to safeguard what refills your cup. More than ever, everyone on the front line should establish and adhere to realistic expectations on the job, where the line is between work and home, and what you should read and share during these crazy times.

    Setting boundaries between realistic and unrealistic expectations of yourself as an EP keeps you from believing that you are less worthy when you fail to meet increasingly high benchmarks. The business of medicine will gladly exploit your overachieving nature and sacrifice your wellness on the altar of unrealistic goals—if you let it.

    More Sacred than Metrics

    Find your inner temple about what defines good doctoring, and hold that as more sacred than metrics. Mine is to try as hard as I can and work at my fastest yet still safe pace. I draw the line at expecting myself to excel at every benchmark. I insist on treating every person the way I want to be treated, but I'm not superhuman and I say no to verbal abuse and groveling to a consultant or patient who cannot be pleased. One of my goals as a nocturnist is getting my ED caught up before the day shift, but that's not realistic every shift; some nights are just too busy, and that's the nature of emergency medicine. Realistic boundaries are imperative to keeping your sanity.

    Never underestimate the importance of drawing boundaries on your calendar. It can feel nearly impossible to secure time for yourself in a specialty that needs us 365/24/7. Too often we don't speak up about our scheduling needs because we don't want to be “difficult,” or we do things from a sense of obligation, a sure path to burnout. Put logistical effort into blocking off vacation time in advance so you can get a whole week off. Even when you cannot take a full vacation, request at least a few days off during busy times so you get a mental health break. This spring, between COVID fatigue and my son's football games conflicting with my normal night shift schedule, I've asked for more time off than ever, and sadly I feel guilty about it. Try not to let yourself feel guilty about requesting time off. Occasionally adjusting work-life boundaries to make more time for yourself is healthy.

    Set boundaries to make sure your time off is truly time off. Say no to overscheduling. Say no to the mentality that you must be productive every moment. Whatever was left undone while you played with your kids or walked your dog is less important to your mental health.

    Most importantly, say no to the intrusions that arise from being hyperconnected and overly accessible. Just because you can check email 24-7 doesn't mean you should. You are not leaving work at work if you get home, pour a glass of wine, and log in to finish charts.

    Maybe see fewer patients and chart in real time, or if you are like me and would rather keep up with patient flow because you cannot tolerate red on the board, spend a focused 30 minutes at work to finish charts so you don't waste precious time at home distracted by charts, not to mention a perfectly good glass of wine. It was eye-opening when my son asked, “Mom, what's a chart?”

    Stop Doomscrolling!

    Once you free your home life from the clutches of work, think about setting boundaries for what you read and watch. It's called doomscrolling for a reason. Don't check your phone when you wake up, are in the bathroom, or stopped at traffic lights. I remember the days when news was limited to the morning paper and the nightly broadcast, and even then my parents warned about watching too much TV.

    It seems society's sense of caution about screens has gone out the window. You don't need to know about the latest disaster the second it happens, and you don't need to read about it incessantly. No one needs that much interaction with all the calamity and anger out there, especially not EPs who already see disproportionate amounts of trauma and death. To safeguard your mental health, set boundaries on how often you check your phone and how long you scroll.

    Be judicious about what you say and share too. It's tempting to shout from the rooftop when you feel happy or stressed, but setting boundaries on how many thoughts you broadcast helps protect your mental health from the judgment of those with differing views. Many EPs are emoters, which works when you have the space to explain yourself. Social media, however, is a different beast; isolated comments can be taken the wrong way and open us to the digital thunderdome.

    Venting may feel cathartic, but I often feel remorseful about spewing more negativity into a world already filled with too much hostility. You don't need to vocalize every thought, something I struggle with. Keeping some things to yourself and maybe your closest confidantes grants you the peace of doing and thinking what you want without having to worry about anyone's response. Not everything needs external validation.

    One can't look at the news these days without getting the message that physicians are stressed. Only we can prioritize our wellness, and we must make changes for our mental health. We can't control the chaos of the pandemic or the ED, but we can set boundaries for how we navigate through it. Let's be our own heroes by saying “no” more often and asserting boundaries to protect our happiness.

    Dr. Simonsis a full-time night emergency physician in Richmond, VA, and a mother of two. Follow her on Twitter@ERGoddessMD, and read her past columns at

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