Boundaries in medicine: How can we preserve our wellbeing, while still sharing our humanity?

Gaye Cunnane describes how for her the essence of a fulfilling career in medicine is grounded in connection

Traditionally, physicians have been advised to maintain invisible but firm boundaries between themselves and their patients. This sense of space is thought to help ensure professionalism and preserve a doctor’s ability to witness and be involved in difficult decisions about other people’s lives without carrying the burden of being too emotionally invested. In many ways, that makes sense.

Yet as a young doctor, I found building and maintaining those boundaries quite challenging. I was fascinated by other people’s lives, many of them with experiences I could only imagine. I was filled with sadness when they experienced serious illness and loss. And I could not hide my happiness when the news was good, or when something wonderful or hoped for became reality. I welcomed and appreciated the hugs of joy or grief.

As I progressed through training and took on more senior roles, I continued to contemplate the pull between self-preservation and empathic connection. Were these mutually incompatible entities? Could I survive a life that embraced the emotional ups and downs of both medicine and patients’ experiences? Could I enjoy this profession without them?

I discovered that for me the essence of a fulfilling career in medicine is grounded in connection. It is in recognising the common humanity of all those around us: our patients, of course, but also their loved ones and the wider community of those who care for them. This encompasses not just health professionals, but support staff too, such as secretaries, cleaners, porters, kitchen workers, lab staff—everyone who is devoted to the welfare of those in our charge. We all have a vital role in caring for patients and their families. But, in the context of a frequently challenging work environment, we have an obligation to look out for one another too.

We are fortunate in medicine. Our work has a purpose, a meaning, a chance to make a difference, small or large. Each interaction changes us, contributes to our sense of wellbeing or despair, energizes or depletes us, in countless, complex ways. Busy medical practices, frequently hectic and stressful, almost never give us the time or space to acknowledge these emotions, or to take stock of those fleeting times where such a connection is made, where a moment of understanding or clarity, of empathy or compassion, changes the course of a patient’s relationship with their illness, or a family’s grief at their loss.

A few days after my father died, I was in my clinic, still shocked at his rapid and unexpected death. My first patient sat in front of me and promptly burst into tears. Through her sobs, I learnt that her own father had died recently. I was horrified at the coincidence and very much afraid of my own reaction, but running away, obviously, was not an option. I took a (very) deep breath and listened quietly as she recounted her sadness and trauma, her regrets and frustrations. Finally, after a few minutes that seemed much longer, she paused, dried her eyes, and told me how much she appreciated my kindness and the time I had taken to listen. Acknowledging and understanding her pain, as well as my own, was memorable for both of us.

And thus, I learnt to recognise my own emotions in the everyday hustle and bustle of life in the medical world. I discovered the knack of appearing to slow down, to use my time well, knowing that if I only have five minutes with a patient, I will give that person my undivided attention. Where time is limited in quantity, I will offer quality. Paradoxically, this does not increase the stress, but rather reduces it and saves time in situations where a patient can say not only that “I saw the doctor,” but that “the doctor saw me.”

Our duty of care in this regard is not just limited to patients and their relatives; we also need to “see” our coworkers and notice when something is awry. A favourite part of every afternoon at work is when our cleaner comes into the office and we chat briefly on topics ranging from the personal to politics, a revealing few minutes when I will know if she is okay or having a tough day. And when her colleague tells me “Mind yourself on the way home, see you tomorrow,” in that simple statement, it’s nice to feel the warmth of someone’s care.

Yet in managing boundaries, the most important lesson I learnt is that of self-care. This lesson came late and was not natural for me. I assumed that caring for others was the only priority and that I would always, willingly, be second in line. Recognising my strengths and weaknesses, knowing my goals, and allowing time for the things I felt passionate about, both inside and outside work, meant that I could give my best without feeling depleted. In healthcare, boundaries are around us rather than between us, regardless of our professional or personal involvement. We need to be able to see them for what they are, respect them, and keep them safe.

Reflecting on our shared purpose in healthcare, I am reminded of a week I spent walking along the Camino de Santiago in Spain. I didn’t expect it to be life changing, but it touched me in unexpected ways. We met people from every walk of life, from every part of the world, all on the same path, heading in the same direction. Some moved energetically, others struggled under the weight of their backpacks. We found no strangers—just friends with shared smiles and the ubiquitous greeting of “buon camino” as we passed by. At lunch stops, we swapped sandwiches and stories, sympathised with blisters, offering band-aids and consolation. We bolstered each other and together we made it to our destination.

Likewise, in medicine, we are all working towards the same purpose, sharing our common humanity, easing suffering where we can, and—with courage and humility—becoming changed and enriched by the experience.

Gaye Cunnane is a professor of medicine and rheumatology at Trinity College Dublin and St James’s Hospital Dublin. She is also the director of health and wellbeing at the Royal College of Physicians of Ireland.

Competing interests: None declared.