John D. Kelly IV, MD, is a professor of orthopedic surgery at the University of Pennsylvania. He focuses his blog on helping surgeons reduce stress while achieving balance in their practices and families.

BLOG: Maintain boundaries to stave off burnout

Burnout rates continues to increase among health care providers and it seems there is no end in sight. In short, burnout is the manifestation of energy depletion. Our emotional “well” has run dry.

One meaningful safeguard against energy dissipation is the establishment and enforcement of boundaries in our lives. We cannot be all things to all people. When we ignore boundaries, we sacrifice and jeopardize all that is important and sacred to us. Setting boundaries is fundamental to ensuring healthy, mutually respective relationships and is a measure of self-esteem. Paradoxically, healthy boundaries afford us the opportunity to be compassionate. The more we love and nurture ourselves, the more we can genuinely love others.

Boundaries are simply the emotional, physical and mental limits we set with others that determine what we deem as acceptable. Boundaries protect us from being manipulated, used or violated by others, and afford us separation of our genuine selves from the thoughts and feelings of others.

Weak boundaries leave us vulnerable to hurt and exploitation, and promote relationships that are not in our best interests. Joy dissipates, peace languishes and our energy well runs dry when we fail to separate our needs and identity from others.

Healthy boundaries are predicated on the principles of taking responsibility for our emotions and actions, and not taking responsibility for the emotions and actions of others.

Poor boundaries cause us to either stumble into taking on too much responsibility for others or expect others to assume responsibility for us. Boundary failure is largely the result of poor self-esteem, a dysfunctional childhood and poor role modeling.

However, healthy boundaries can be learned and implemented. It is never too late. The institution and enforcement of the following practical boundaries will do much to ensure a more balanced, energized and burnout-proof life.

When you are home you are home

Many of us carry the stress of the day home to our loved ones. We find it hard to dissociate from our occupation. The laptop looms, the iPhone entices us to check one more text and the journals serve as a call to “stay current.” Meanwhile, our spouses or partners are dying for some undivided attention from us and children eagerly wait for some measure of attention.

I learned the hard way that when I bring work home, I never allow my nervous system a respite from the stressors of the day. I also recognized that when I was present with my family, my home life was happier and more joyful.

Try to do all essential work before coming home. Your personal sacred space is your home. Make it your haven. Do not adulterate it with work. Your loved ones will take note of the boundary you set as the “orthopedic no-fly zone.”

Vacations should be vacations

Another boundary often obscured by surgeons is vacation/work. Early in my career, I made the mistake of mixing work with play. Every “vacation” was an orthopedic conference where I often was giving a presentation. There was simply minimal unabashed dedicated family time as I prepared my slides or retired early for the 7 a.m. “not to be missed” first lecture. My family needed all of me and I have since learned that any mention of work will poison, even the best-intended family plans.

Our families have endured many sacrifices and they are deserving of dedicated, bullet-proof vacation time. Love others as you love yourself. Self-love and self-respect are the cornerstones of all effective boundaries. We are obliged to transmit a clear and firm portrayal of our psychological limits; that is, what action or behavior causes us emotional harm?

We are each endowed with profound dignity and worth. Any behavior directed toward us that is subversive to our personal honor is to be rejected. Intolerance of any action or encounter that violates our intrinsic worth will boost our self-image and self-worth. When you are asked to do something by a colleague that is beneath your dignity or mores, feel good about saying “no.” Your honor is priceless.

When a patient uses language not becoming of your standards, a simple correction is perfectly indicated. If an associate asks you to perform a task that they are perfectly capable of executing on their own, a simple no will go a long way to affirm your own worth and preserve your honor. Being kind does not mean being a pushover. You are responsible for how others treat you. Just say, “No.”

We cannot be all things to all people. When asked to give a lecture, perform an elective surgery, write a chapter or cover call, first consider whether you should or wait to do the said action. When we remain faithful to the “wants” and minimize the “shoulds,” we are protecting our boundaries.

 Once you have established clear and attainable personal boundaries, others will ultimately render you more respect. In time, you will become more of your authentic self, asking for what you truly desire and need for your personal happiness and fulfillment. Healthier, more loving and more energy-sustaining relationships in your life will manifest, while those that zap you dry will get the message.



Cloud H, et al. Boundaries: When to say yes, when to say no, to take control of your life. Zondervan, 2004. Grand Rapids, Mich.

Shanafelt T, et al. Mayo Clin Proc. 2015;doi:10.1016/j.mayocp.2015.08.023.

Whitfield CL. Boundaries and relationships: Knowing, protecting and enjoying the self. Health Communications Inc., 1993.

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