The Importance of Boundaries: Setting Healthy Limits in Medical School

As medical students, there is an inherent level of perfectionism and altruism that exists within us.  It's what our future job expects of us to an extent; however, it often comes at the cost of self-sacrifice. I admit, I struggle saying no given how I have equated it with disappointing others: whether it may be a consultant by not staying late to observe another procedure or letting my friends down by not showing up for every gathering, or even to myself by not going the extra mile to ensure I cover all the content before the exam. It's exhausting to put yourself second, and over time you may lose sight of your purpose. That's why boundaries are so important.

I always thought the term boundaries sounded quite firm and even authoritative - everything I felt I was not. In truth, boundaries are not about putting up walls but instead they help you find a balance that allows you to maintain your wellbeing and relationships.  Clear boundaries can be set through self-reflection and effective communication and hopefully the advice below helps you in setting them.

Self-Awareness

The first step to setting boundaries is developing self-awareness. Take some time to establish what you need to function at your best, as well as what you are and are not willing to compromise on. For instance, I know going to the gym makes a massive difference on my physical health and overall mood, so I need to make time for it during the week. For others, it might be about getting enough sleep or simply having an evening of alone time at the end of the week. It might be tempting to neglect your needs whenever placements, exams or life in general gets busy, but recognising that my wellbeing is a key priority helps me to maintain boundaries.

Equally, it's also important to reflect on your limits and on situations or relationships that drain your energy and increase your stress.

Effective Communication

Once you know what your boundaries are, you need to communicate them clearly with others. Stating your boundaries as straightforward as you can makes them less open to interpretation and are less likely to be broken.  An effective way to communicate is using "I" statements, for example, instead of saying " you're distracting me now" you can say, "I'm quite busy now and I would like to focus, can we talk later?".  Similarly, if you are on placement and asked to act outside your competencies you can say " I don't feel comfortable carrying out this procedure. Could you ask someone else or even supervise me?". Using such statements helps put the focus on how you are feeling and helps you assertively place your boundaries without being accusatory.

Consistency is Key

Boundaries need to be constantly reinforced else they run the risk of being interpreted as flexible and could be overstepped. Consistency can be difficult at first. You might feel uncomfortable or even guilty by saying "no" and potentially disappoint others. One phrase that stood out to me while researching this article was: "saying no isn't selfish; it's self-care". It's important to continually remind yourself why you set those boundaries in the first place and know that protecting your self-interests will pay off in the long run. 

Seek Support

Finally, remember to ask for support if you feel unable to establish boundaries. This can be particularly important in medicine, where there are often power dynamics between students and doctors. Seeking help from your support network can help navigate any difficult relationships and sometimes having someone to validate your feelings can help you realise they are justifiable.

Overall, boundaries help you to look after yourself and maintain healthy relationships. Learning to put yourself first when you need to can go a long way in protecting your wellbeing and prevent you from being exhausted by the commitments and activities you enjoy. Often saying "no" now means you are more able to say "yes" in the future.