In 2010, I opened my own private psychiatry practice, and I made all the rules. I wanted my patients to have full access to me. Sometimes I responded back to an email instantly. Sometimes I took a phone call at 9 p.m. Sometimes, I sent in a prescription when a patient asked for it rather than when I thought they needed it.
At first, this worked great. My patients loved my instant responses, and I gave them what they were asking for. After six months, things weren’t so great. I had poor boundaries around my time, and as the number of patients in my practice grew, it became intrusive. I found myself frantically checking email between appointments and dashing off responses without pausing to gather my thoughts. I found myself taking phone calls at all hours of the night and on the weekends. I found that sometimes I prescribed a desired medication which was not really the best choice for the patient.
As I continued to add patients in 2011, I knew something had to change. My boundaries sucked, and as a result, my work sucked too. I saw something interesting — my patients were not doing great either. Because we hadn’t agreed upon any boundaries for our work together, they felt distressed. They didn’t know what to expect from me. If I responded to an email after three hours instead of three minutes, they worried something was wrong and got anxious. If I didn’t respond to an after-hours phone call because I was doing something at home, they got worried, then anxious, then upset, and their mood escalated into a bad state.
I realized the process of setting boundaries was an important part of the patient-doctor relationship. With consistent and thoughtful boundaries, I conveyed empathy, professionalism, and competency. I talked to other psychiatrists and learned how boundary setting was a collaborative expectation-setting exercise that built trust between the patient and the doctor. I revamped my practice boundaries. I practiced doing the boundary-setting exercise collaboratively with patients.
Over the years, this strategy succeeded. After growing my private practice to include other psychiatrists and administrative staff, it became even more important to clarify and maintain boundaries across a population of 800 plus active patients. I codified the boundaries in our operations manual, and we trained on the boundary-setting process collaboratively with patients.
In all the different places I worked, with all the different leaders I coached, and the clients I consulted with, I have rarely seen this type of collaborative boundary setting in the workplace. Typically, I have seen either 1) silent, assumed, and social norms, 2) highly structured employee manuals which are on paper but not followed in reality, or 3) explicit team-based norms that are variable across the organization.
Without explicit collaborative boundary setting in the workplace, employees feel like my patients. They are worried they are doing something wrong, anxious when they don’t hear back immediately, moody and depressed because they feel they do not have the ability to say no. Humans feel a general lack of control when the boundaries are vague.
