How do you create healthy boundaries in your practice?

For the most part, your patients are probably wonderful people who you LOVE helping. But we’ve all had those patients who… well, aren’t very lovely to work with. You know the ones. They’re the patients who seem great at first but then they slowly start to test your limits or cross the line.

Maybe they text you on the weekends wanting advice for their achy knees. Or they email you because their mom was diagnosed with a fatty liver and they need your nutritional wisdom on her behalf (for free). These types of patients may not even realize they’re overstepping boundaries and expecting things from you that you didn’t even offer to provide.

So, you try to gently nudge them in a different direction, but they’re not getting the hint. And because you don’t want to risk losing them, it puts you in an awkward spot.

Do you modify your boundaries to accommodate, or do you stand your ground and risk losing them?

Having a wellness practice for over 18 years has taught me a thing or two about keeping healthy boundaries. And working with hundreds of practitioners as a business coach has confirmed that most of us don’t know how to do it well. If there’s one thing I do know, it’s this: make sure you establish clear boundaries as early in the patient relationship as possible. 

Doing this can be tricky at first, and uncomfortable to enforce but here are my four down-and-dirty steps for helping you create and maintain healthy patient boundaries before the going gets tough.

1. Know Why You Don’t Have Boundaries Now

Like many other clinicians, you probably haven’t given much thought to why you don’t have clear boundaries established for your practice. My friend, you should know your non-negotiables as well as you know your ABCs.

But before you create those boundaries, get clear on why you don’t have them in the first place! So, let’s do an exercise. Grab a cup of tea and a notebook and get cozy in your favorite chair. Ask yourself:

• What are your beliefs around setting boundaries in your practice? Are they scary? Are they something you thought about having before but weren’t sure how to communicate them? Would it be better to just pretend you have them when in reality, you don’t? 
• If you had boundaries and a patient stepped over them, would you feel comfortable addressing it? How would that make you feel? Would you feel like you’re letting them down for not doing what they’re asking? 
• How would you respond if you lost a patient as a result of enforcing your boundaries?

Once you have clarity around your motivation for having boundaries, you’ll have the clarity to see what boundaries you need and have the ability to create and define them.

2. Decide What Matters Most to You

Your core values are the principles and priorities that shape your choices and the direction of your practice. They help you to show up more dynamically for your patients and be a leader in your professional network. These core values are a critical part of helping you define your expectations and develop healthy boundaries.

So, take a few moments to get clear on your core values and create boundaries that center around them. For example, if family time is important to you, you may want to develop boundaries around not responding to work emails on nights or weekends. When you define your core values, it becomes clear that this boundary isn’t about avoiding your patients – it’s about honoring what’s important to you which is being present with your loved ones.

And when you take the time to define your values and create boundaries around those values, then it’s much easier to stick to your guns when a patient pushes against them. 

3. Take Matters Into Your Own Hands

The cold hard truth is – you can’t change others. As much as you may want to, you can’t control that one patient who always calls you to tell you about his latest symptom, ache or pain. You can’t go in and do a complete personality overhaul on the Chatty Cathy who loooooves to tell you all about her grandkids and causes you to run late for the rest of the day.

You CAN control how you deal with these unique situations. So, when you’re creating boundaries, take it a few steps further:

• Decide what happens in advance if your patient pushes against a certain boundary you’ve already established. For example, if they insist you respond on weekends, have a response thought out in advance which makes it easier to nip in the bud.
  
• Plan how you’ll communicate your boundaries, and what will happen when boundaries get crossed. Using the “no nights and weekends” example, decide how you’ll let your current patients know when you’re off-limits. Also, think through how you’ll proactively tell your new patients. I’d recommend adding this information to your Office Policies which should be part of in your new patient forms.
  
• Communicate the boundaries for your practice in multiple places – your new patient handouts, on your website, with your staff, etc.

Once you share your practice’s boundaries, now the real fun begins… 

4. Stand Firm and Be Consistent

You can have the best boundaries in the world, but they won’t do you any good if you don’t clearly communicate them and then stick with them. Consistency is key here, my friend. It shows that you’re a confident clinician with a strong character – a clinician who says what you mean and means what you say. 

Some patients are gold medalists at testing your limits and pushing the line. I know it’s tough, but the more you stick to your guns and hold them accountable, the better off everyone will be. I promise. 😊

Need Help Creating Boundaries for Your Practice?

I know how scary drawing boundaries can feel. Maybe you’re still figuring out what’s important to you. Or perhaps you’re feeling a little afraid to draw a line in the sand. If that’s you, I totally get it. If you need help to get you where you want to go, check out the How To Set Clear Boundaries With Your Patients podcast episode I recorded on this very issue. 

In it, I give you specific tips that will help you create healthy boundaries that are perfect for your practice and for you. And the best part? These boundaries will help save you the awkward headache of dealing with a boundary-pushing patient on the back-end. Prevention is key. Let’s stop the problem before it starts.