Setting boundaries, focusing on purpose can promote resilience among women in medicine
According to Laurie K. Baedke, MHA, FACHE, FACMPE, saying “no” on its own stands as a complete sentence.
“You can toss a ‘thank you’ on there, or you can start a new sentence that says ‘thank you for the opportunity, however...’ and then deliver your ‘no,’ but it is a complete sentence on its own,” Baedke, a faculty member and director of health care leadership programs at Creighton University, said in her talk at this year’s Women in Medicine Summit. “Please don’t feel obligated to apologize. Sometimes the systems and structures around us thrive and operate on the altruism of people like you and me and our colleagues around us. Only we have the ability to say ‘no.’”
Baedke’s presentation on setting boundaries addressed the tendency of female physicians to be “people pleasers”; the current misuse and manipulation of the word “resilience”; and the need for clinicians to tend to their physical, mental and social well-being to provide the best care for their patients.
“I had a different talk planned for this plenary session, but I reached out to Shikha Jain, MD, FACP, literally 48 hours ago,” Baedke said. “I felt so compelled that in our current reality in health care, it was critical that I push this topic forward.”
‘Bouncing up’
Baedke said although recent attention to the importance of resilience has been valuable, the overuse of it — particularly in the context of overextending a person’s time or commitments — can be problematic.
“[Merriam-Webster’s Collegiate Dictionary] defines ‘resilience’ as the ability to withstand or recover quickly from adverse conditions — the ability to recoil or spring back into shape after being stretched, pressured or squeezed,” she said. “I like to use the image of a rubber band as a metaphor for resilience. That little piece of office supplies has spectacular ability to stretch. I can put it around a big stack of papers that I’m carrying across campus. Then when I’m done with it, I can put it back in my drawer and bring it out the next time. As long as it’s in its original condition, it can stretch and go back and do something different. But if I put it around a gigantic stack of papers and I set it on the shelf or my windowsill, and the conditions around it cause it to become dry and brittle, it might not work as well. So the environment around us can impact our ability to be resilient.”
Baedke said the phrase “bouncing back” implies a return to the status quo and cited the concept of “bouncing up,” which has been championed by Julie A. Freischlag, MD, FACS, CEO of Wake Forest Baptist Health, dean of Wake Forest School of Medicine and chief academic officer of Atrium Health Enterprise.
“There is a Latin phrase for this, ‘per ardua surgo,’ which means ‘I rise through adversity,’” Baedke said. “We have to adapt. We have the option, as we experience hardship, to either ‘bounce back’ to the way things were, and the way our structures and systems operate, or to heed Dr. Freischlag’s call to action and bounce up.”
Principles of resilience
Baedke outlined four principles that can help improve resilience and guide individuals and organizations toward maintaining healthy boundaries. These include managing the margin, investing in growth, curating your circle and knowing your purpose.
Managing the margin, Baedke said, pertains to the idea that simply taking time off from work will not lead to healing if the problem is how a person is spending their time.
“At no time have circumstances been more taxing to health care professionals than this moment,” she said. “The call to action for systemic and structural change is sky high, but it’s also naive of any of us to think that just a day or a week off will fix us when we have to manage how it is that we spend our time.”
Investing in growth pertains to all aspects of growth, especially knowledge. Baedke emphasized the need to continue to grow knowledge, citing the 91-year-old business magnate Warren Buffett.
“He’s known for his financial prowess in investing, but he’s also a passionate advocate for our investing in knowledge,” she said. “He says that knowledge builds up like compound interest. In a quote of his, he says, ‘All of you can do it, but I guarantee not many of you will do it.’ How we expand our learning and awareness of these factors will equip us to counter what is going on around us structurally or systemically and will help nurture our well-being and resilience.”
Baedke’s third principle is to curate your circle. This concept holds that a person’s well-being will be influenced by the five people with whom they keep the closest company, a view expressed by former Dyson CEO Jim Rowan.
“We espouse the habits of people we hang out with,” Baedke said. “These might be your peers, your mentors, your sponsors, your friends. They might be players in your organization or institution or national thought leaders, or individuals outside your profession.”
Baedke’s fourth and final recommendation is to know your purpose. This allows a person to prioritize and reinforce necessary boundaries.
“Maybe it’s in relationship building, maybe it’s a passion for teaching — there are so many ways each of you in beautiful and diverse ways find purpose and meaning in your work,” she said. “Those are the things that will restore you and allow you to carry on.”
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Baedke L. No, Thank you. Boundary setting that bolsters resilience and well-being. Presented at: Women In Medicine Summit, Sept. 24-25, 2021 (virtual meeting).
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