Whether a thinker or a feeler, this is how to manage boundaries in general practice
As I call out for Ruth* in the waiting room, she is flicking through a mountain of paperwork. She is a relatively new patient for me as things had turned a bit ugly with her last doctor.
She has widespread undifferentiated musculoskeletal pain that started after a work injury and is struggling in all facets of her life.
Once we get through her main issues, she wants me to download a form.
“I’m not exactly sure which one,” she says, “but the people at Centrelink told me you would know which one I’d need. You can fill it out later and I can pick it up this afternoon if you like?”
In the five consultations I have had with Ruth over recent weeks, there is always more she wants than is humanly possible for our allocated time.
There is her overwhelming pain, the medication, the referrals she wants for imaging and the multitudes of paperwork she wants me to fill out, let alone unravelling the reasons for this difficult pain and working out the best way to support her through this.
After the appointment, she invariably leaves me a couple of messages for a phone call or another thing she wants me to do that she forgot to mention in our appointment.
I know that Ruth is overstepping a boundary with me because I feel somewhat violated after my interactions with her.
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Many GPs are so attuned to our patients’ needs we neglect our own needs in the transaction that takes place when we see a patient.
We usually do what they ask of us, even if it is unreasonable, and avoid the negative Google review.
We all have a handful of patients like Ruth, who still demand more even if we bend over backwards to accommodate them.
The concept of boundaries is something I still struggle with despite my many years of practice.
Boundaries are limits and rules we set for how we would like to be treated and, ideally, are communicated proactively rather than reactively after an incident.
Being clear about these boundaries can be difficult if we have a patient who continues to push them, but it is an investment worth making.
Understanding your personality type can help inform where your blind spots are and may explain why some GPs find it more difficult to assert their boundaries.
GPs who are more attuned to patients’ emotions and feelings often find it more difficult to assert their own needs.
In the Myers-Briggs personality types, these doctors are the feelers rather than the thinkers.
Feelers strive for harmony and acceptance and are naturally empathetic, but they are more likely to overcommit and have difficulty saying “no” and setting boundaries.
Thinkers are more driven by logic than emotions, and don’t always consider how people will feel when they make decisions. They are more efficient in their consultations, but sometimes their patients don’t feel heard.
Feelers need to be more conscious about setting boundaries, and thinkers need to be more conscious about active listening.
According to several studies, up to 65% of women are feelers compared with 40% of men. So even though women are more likely to be feelers than thinkers, there are still a high proportion of men who are feelers.
So, what can we do to support ourselves and manage boundaries if you are a feeler?
Someone much wiser than me once said that to be kind to others, you must be kind to yourself.
Where is the line between kindness and burnout for you? When you are feeling resentful about patients and how they are treating you, it is likely a boundary has been crossed and you have reached your giving limit.
Boundaries are built on a foundation of self-worth. We need to recognise our value and respect our worth. For me, this means that I now privately bill and I don’t do paperwork for nothing.
I have learnt that getting all the issues out at the start of the consultation is time well-spent and helps me manage a patient’s health and their expectations. This may involve respectfully interrupting them at times to get the big picture rather than going down a rabbit hole.
Once you know the whole situation, you can share the decision-making of what you have time to work on during the current appointment. You may need a series of appointments to work through all their concerns.
Consultations with particularly demanding patients often benefit from a clear structure and firm limits. Possibly the feelers could take a page out of the thinkers’ book and the thinkers out of the feelers’ book.
Make it clear that they have a 15-minute appointment, and if you run out of time they will need to book another appointment to work through their issues.
Proactively managing our boundaries often involves making significant changes in how we do things.
Prioritise your self-care and don’t ignore the feelings that come up when someone pushes you too far. It will inevitably involve having difficult conversations with some of your patients.
*Ruth is an amalgam of several patients.
