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The power of setting boundaries

Dr. Lawrence Yang's story on Self-Care
Dr. Lawrence Yang

I was a prototypical family medicine hopeful. I had gotten straight A’s in high school, fared well in undergrad, excelled on the MCATs. Medical school felt easy for me. I cultivated compassion for others and  was a natural giver, consistently making space for those in my care. The culture of my medical residency in Brooklyn, NY taught me about pushing my body through healthy boundaries of energy preservation and about leaning into intellectualism.

By my 3rd year of full-service family medicine practice, following my own patients from clinic into hospital at Surrey Memorial Hospital, I was fully burnt out. My burnout manifested as physical pain in inflammatory arthritis and enthesitis and dactylitis. My body was screaming for the attention and rest that I had deprived it of for nearly a decade of training and attending hood. My nurse team members would comment to me how I was “enabling” my patients. I fought my nurses and dismissed their wisdom.

“By my 3rd year of full-service family medicine practice […] I was fully burnt out.”

I knew intellectually that rest and a healthy diet were important for health – indeed that’s what I preached to my patients, but deep down, I think I did not believe that I deserved good care. I think that a large part of my “giving” nature was driven by a deep desire for being valued by those I helped and being needed. I was trying to fulfill my desire for being needed by over-working to serve others. I had a perverted sense that I needed to rescue some of my patients, that if I was not there for them that they would somehow perish. My ego needed work.

My body forced me to slow down from work. A kind family doctor in Dr Singh and a kind rheumatologist in Dr Khayambashi gave me safe spaces to reflect. As I started on biologics and limped around my clinic from exam room to exam room, as I hobbled along in my home with my children using a walker, I spent time reflecting on how I had gotten into the situation where I was not even 40 years old but nearly disabled. I had paid no attention to my energetic boundaries. I had chosen to take on the sufferings of others as my responsibility. I chose to be responsible for the financial and social well-being of my patients. I tried to do all of this alone, a silly martyr for an invisible cause. I realized that if I wanted to be a better physician, I needed to be intentional about setting healthier realistic boundaries.

I realized that I needed to ask for help if I wanted to have more sustainable medical practice. I needed to start trusting my medical office assistants to help me with higher skill tasks. I needed to ask my colleagues to cover for me. I needed to learn more about team leadership. I needed to learn about the science of teamwork. I needed to set firm stop times on my workdays and schedule in meal prep and regular exercise.

I reached out to coach Nathalie Martinek who I look to as a specialist in burnout. One of the principles of coaching is that people are capable of growth, change, and improvement way more than we can imagine. I learned that if we, as well-intentioned helpers, over-reach, we can be slowing down the other person’s journey of empowering self-discovery.

In learning to trust my team members, my colleagues, and my patients, I slowly came to see that my self-worth is not tied into my level of self-sacrifice to help others. I came to trust that my self-worth is immutable, unchangeable, and intrinsic. Now, in my 18th year as a medical doctor, I have been pain-free for over 6 years and enjoy training and excelling in Brazilian jiujitsu and being a sustainable helper as a joyful peer-coach and family doctor.

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