Since the days of my medical training, I have been good at setting and holding professional boundaries with my patients. It’s possible to have both empathy and limits. As a consulting physician, I struggled much more with setting boundaries with my colleagues.

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Once, when I was a brand-new attending physician, it was my turn to see patients at Mainland Hospital. This was the less busy hospital for our practice, and the one closer to my home. One afternoon, I was able to get home early, and I was running around in the back yard with my three-year-old son. My pager went off; it was a stat consult.

The cardiologist wanted me to see the patient right away, not because of medical urgency, but because the patient had VIP status. He was a psychiatry resident, and he’d been running unexplained fevers for several weeks. There wasn’t really anything for me to add so early in the diagnostic process.

The results of all the blood tests and cultures were pending, and nothing would be back until the next day. But, being new, I was anxious to make a good impression, so I changed out of my jeans and back into stockings, skirt, and heels. I drove the three miles to the hospital.

First Lesson

I stood at the nurse’s station with the cardiologist while we discussed the case. “Thanks for coming so quickly,” he said. I began to understand that there was some flexibility in the rules. The written regulations said a stat consult was to be seen within an hour, but apparently that wasn’t expected in the culture. I was learning.

Between 1994, when I first started, and 2003, the first time I declined a stat consult, not much changed in my desire to appear helpful and conscientious. In 2003, though, my son’s health crisis took priority. I was sitting with my husband beside our son’s hospital bed at CHOP when my pager went off.

I went walking to find a private place to call the unit secretary. I entered a sunny hallway, a bridge between two different wings of the hospital. There was a wide windowsill for a seat, and there was hope that being near a window would give me a strong phone signal.

Second Lesson

“This is Dr. Bayer. I’m calling back about the stat consult you just called in.”

“Yes, the doctor said he wants you to see the patient today,” said the unit secretary.

“I’m with my son at CHOP right now. Please call the doctor back and ask him to give the consult to another ID physician on staff.”

“Oh, okay. I’ll tell him.”

It may sound like it was easy for me to say these words, and in those circumstances, it wasn’t easy, but it was possible. I felt a rush of relief as I walked back to my son’s room. And I learned another lesson.

With my first stat consult, I learned that my timely response was unusual. With this latest declined consult, I learned that the world didn’t end. It kept on going as it always had. It was a first glimpse of what was possible if I set boundaries with my colleagues and held to them.

Question: In what situation do you find it hard to say no or to set limits? What have you learned from saying yes? What have you learned from saying no? Leave a comment below and let me know.