WELLNESS COMMITTEE
Self-Compassion, Self-Valuation, and Boundary Setting in Emergency Medicine Al’ai Alvarez, MD*
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any of us work multiple clinical shifts while also balancing time with friends and family. For those of us in academic practice, there are also never-ending deadlines for papers, national talks, and grant applications. There are also the learning modules we have to complete by the end of the year. While we can aim to be more efficient—and there are experts on this in emergency medicine (EM) such as Dr. Jennifer Kanapicki and Dr. Christina Shenvi— we must also acknowledge that the list will continue to expand, and there are only so many hours in a day. This is where boundary setting is essential. To start, it’s important to acknowledge that it is not easy to set boundaries. This takes practice and we will likely fumble more at the beginning. But we owe it to ourselves to try. Boundary setting requires that we learn how to say “No” to some commitments and opportunities. As EM physicians, we have high standards and expectations which often leads to compromising our own needs, such as time for ourselves or our family. Balance, therefore, equates to conflict. Dr. Kristen Neff has done a lot of work on self-compassion.1 She highlights three main components: • Self-kindness: the act of nurturing and showing tenderness to ourselves in our moments of struggle. • Common humanity: these moments of struggles are not unique to you alone, and suffering is a part of being human. • Mindfulness: having self-awareness of the experience of suffering without over-identifying with it. In her recent work, “Fierce Self Compassion,” Dr. Neff highlights the importance of also “acting in the world” to include “protecting, providing for, and motivating ourselves.” It refers to self-advocacy and standing up for ourselves, setting boundaries, and fighting for injustice.2
frustrated are all normal reactions to stress. Can we see how much of this is within our circle of influence? Can we safely see one more patient so we can somehow help with the overcrowding? We can also see how much of this is due to the inefficiencies in the system. Fierce self-compassion and boundary setting allow us to notice at the moment that we have the capacity to be intentional with our decisions. We can focus on our current patient load instead of sacrificing quality patient care just to increase the number of patients being seen. Or perhaps we can call for help. We can be clear about what it means to care for our patients vs. pathologic altruism that compromises our own well-being.
How does this translate to saying “No” to yet another committee project? How about managing an overcrowded emergency department?
Boundary setting is a form of self-compassion. In physician well-being literature, self-valuation refers to the “constructive prioritization of personal well-being and growth mindset perspective.” The same team did a multicenter study, which showed a clear dose-response relationship between self-valuation and burnout, and self-valuation and sleep-related impairment.3 Physicians with high self-valuation scores sleep better and have less burnout.
By practicing self-kindness, we focus on understanding our own needs as well. We are protecting our own well-being and providing ourselves with options, including the option to say “No.” Understanding the common humanity means that just like me, the number of responsibilities you currently have feels overwhelming and that you are not alone in experiencing this. Mindfulness allows us to have the clarity to decide what needs to be done right now, what can wait, and what we hope for ourselves.
Practicing self-compassion takes courage. Know that you are not alone in this experience, and when you leave the emergency department, there is no doubt that more patients will arrive. Self-compassion does not mean abdicating our role as physicians. It means advocating for our own well-being by developing clear boundaries so that we can be more effective and caring towards our patients and each other when we show up to work.
When the waiting room continues to fill up, we can notice this discomfort. We can acknowledge to ourselves that feeling anxious, angry, or 36
To start, it’s important to acknowledge that it is not easy to set boundaries.”
COMMON SENSE JANUARY/FEBRUARY 2022
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