More Than A “No”

A lot of people struggle with boundary-setting, and it’s not always the way you might think.

The person who “can’t say no” to people probably comes to mind, but the problem is more far-reaching than that, and it’s rooted in not being clear over what a boundary actually is.

For example: “Don’t bring him here again!”

Pretty clear, right?

And while it is indeed clear, it’s not a boundary; it’s a command. Which may or may not be obeyed, and at the end of the day, what right have we to command people in general?

Same goes for less dramatic things like “Don’t talk to me about xyz”, which can still be important or trivial, depending on whether the topic of xyz is deeply traumatizing for you, or mildly annoying, or something else entirely.

Why this becomes a problem

It becomes a problem not because of any lack of clarity about your wishes, but rather, because it opens the floor for a debate. The listener may be given to wonder whether your right to not experience xyz is greater or lesser than their right to do/say/etc xyz.

“My right to swing my fist ends where someone else’s nose begins”

…does not help here, firstly because both sides will believe themself (or nobody) to be the injured party; for the fist-swinger, the other person’s nose made a vicious assault on their freedom. Or secondly, maybe there was some higher principle at stake; a reason why violence was justified. And then ten levels of philosophical debate. We see this a lot when it comes to freedom of expression, and vigorous debate over whether this entails freedom from social consequences of one’s words/actions.

How a good boundary-setting works (if this, then that)

Consider two signs:

• No trespassing!
• Trespassers will be shot!

Superficially, the second just seems like a more violent rendition of the first. But in fact, the second is more informationally useful: it explains what will happen if the boundary is not respected, and allows the reader to make their own informed decision with regard to what to do with that information.

We can employ this method (and can even do so gently, if we so wish and hopefully we mostly do wish to be gentle) when it comes to social and interpersonal boundary-setting:

• If you bring him here again, I will refuse you entrance
• If you bring up that topic again, I will ask you to leave
• If you do that, I will never speak to you again
• If you don’t stop drinking, I will divorce you

This “if-this-then-that” model does the very first thing that any good boundary does: make itself clear.

It doesn’t rely on moral arguments; it doesn’t invite debate. For example in that last case, it doesn’t argue that the partner doesn’t have the right to drink—it simply expresses what the speaker will exercise their own right to do, in that eventuality.

(as an aside, the situation that occurs when one is enmeshed with someone who is dependent on a substance is a complex topic, and if you’re interested in that, check out: Codependency Isn’t What Most People Think)

Back on track: boundary-setting is not about what’s right or good—it’s about nothing more nor less than a clear delineation between what we will and won’t accept, and how we’ll enforce that.

We can also, in particularly personal boundary-setting (such as with sexual boundaries’ oft-claimed “gray areas”), fix an improperly-set boundary that forgot to do the above, e.g:

“How about [proposition]?”
“No thank you” ← casually worded answer; contextually reasonable, and yet not a clear boundary per what we discussed above
“Come on, I think you’d like it”
“I said no. No means no. Ask me again and I will [consequences that are appropriate and actionable]”

What’s “appropriate and actionable” may vary a lot from one situation to another, but it’s important that it’s something you can do and are prepared to do and will do if the condition for doing it is met.

Anything less than that is not a boundary—it’s just a request.

Note: this does not require that we have power, by the way. If we have zero power in a situation, well, that definitely sucks, but even then we can still express what is actionable, e.g. “I will never trust you again”.

“Price of entry”

You may have wondered, upon reading “boundary-setting is not about what’s right or good—it’s about nothing more nor less than a clear delineation between what we will and won’t accept, and how we’ll enforce that”, can’t that be used to control and manipulate people, essentially coercing them to do or not do things with the threat of consequences (specifically: bad ones)?

And the answer is: yes, yes it can.

But that’s where the flipside comes into play—the other person gets to set their boundaries, too.

For all of us, if we have any boundaries at all, there is a “price of entry” and all who want to be in our lives, or be close to us, have to decide for themselves whether that price of entry is worth it.

• If a person says “do not talk about topic xyz to me or I will leave”, that is a price of entry for being close to them.
• If you are passionate about talking about topic xyz to the point that you are unwilling to shelve it when in their presence, then that is the price of entry for being close to you.
• If one or more of you is not willing to pay the price of entry, then guess what, you’re just not going to be close.

In cases of forced proximity (e.g. workplaces or families) this is likely to get resolved by the workplace’s own rules (i.e. the price of entry that you agreed to when signing a contract to work there), and if something like that doesn’t exist (such as in families), well, that forced proximity is going to reach a breaking point, and somebody may discover it wasn’t enforceable after all.

See also: Family Estrangement: More Common Than Most People Think

…which also details how to fix it, where possible.

Take care!

Doctor: “So, how are you today?”
Patient: “Can’t complain; how about you?”

Hopefully your medical appointments don’t start quite like that, but there can be an element of being “along for the ride” when it comes to consultations. They ask questions, we answer, they prescribe something, we thank them.

In principle, the doctor should be able to handle that; ask the right questions, determine the problem, and not need too much from you. After all, they have been trained to deal with an unconscious patient, so the fact you can communicate at all is a bonus.

However, leaving it all to them isn’t really playing the field.

Before the appointment

Research your issue, as best you understand it. Some doctors will be very averse to you telling them about having done this (taking it as an affront to their expertise), but here’s the thing:

You don’t have to tell them.

You just have to understand as much as possible, so that you will be as “up to speed” as possible in the conversation, and not be quickly out of your depth.

Have an agenda, based on the above. Literally, have a little set of bullet-points to remind you what you came in to discuss, so that nothing escapes you in the moment. This should also include:

• If you have additional reasons for a particular concern (e.g. family history of a certain problem), make them known
• If you plan to request any specific tests or treatments, be able to clearly state your reasons for the specific tests or treatments
• If you plan to write off any specific tests or treatments as something to which you will not consent, have your reasons ready—in a way that makes it clear it’s something more than “don’t want it”, for example, “I’ve already decided that this treatment would make a sufficient hit to my quality of life, as to make it not worthwhile for me personally” (or whatever the reason may be for you). It needs to be something they can write on their notes instead of simply “patient refused treatment”.

Compile a record of your symptoms (as appropriate), and any previous tests/treatments (as appropriate), in chronological order. If you take all this with you, perhaps in a nice folder, you will enjoy the following advantages:

• not forgetting anything
• ability to answer questions accurately
• give the (correct) impression you take your health seriously, which means they are more likely to do so also—especially because they will now know that if they fob you off and/or mess something up, you’ll be taking a record of that to your next appointment.

Plan your outfit. No, you don’t have to dress for the red carpet, but you want to satisfy two main conditions:

• Accessibility for examination (for example, if you are going in with a knee pain, maybe don’t wear the tight jeans today; if they’re going to take blood, be either sleeveless or have sleeves that are easily moved out of the way, etc)
• General presentability (it’s a sad fact that doctors are not immune to biases, and will treat people better if they respect them more)

During the appointment

Be friendly; doctors (like most people) will respond much better to that than to grumpiness—even if you have good reason for grumpiness and even if the doctor has been trained to help grumpy patients.

Be confident: when we say “be friendly”, that doesn’t mean to necessarily be so agreeable as to not advocate for yourself. In particular:

• If they explain something and it isn’t clear to you, ask them to clarify
• If you disagree with them about a value judgement, say so. By “a value judgement” here we mean things in the realm of subjectivity. If the doctor says you are prediabetic, then you won’t get much mileage out of arguing otherwise; the numbers have the final say on that one. But if the doctor says “the side effects of the treatment you’re requesting will make it not worthwhile for you” and you have understood the side effects and you still disagree, then your opinion counts for more than theirs—it is your decision to make.
• If they dismiss a concern, ask them to put in writing that they dismissed your concern of X, despite you providing evidence that Y, and it being well-known that Z. Often, rather than doing that, they’ll just fold and actually address your concern instead.

Writer’s example in that last category: I recently made a request for a bone density scan. I expect my bone density is great, because I do all the right things, however, as both of my parents suffered from osteoporosis and assorted resultant crushed bones and the terrible consequences thereof, I a) have reasonable grounds for extra concern, and b) I believe that even if my bone density is fine now, it’s good to establish a baseline so I can know, in 5, 10, 20 years etc, whether there has been any deterioration. Now, happily the doctor I saw agreed with my assessment at first presentation and so I got the referral, but had she not been, I would have said “Could you please put in writing that I asked for a bone density scan, and you refused, on the grounds that [details about what happened with my parents], and that osteoporosis is known to have a strong genetic component is not, in your opinion, any reason to worry?”

Be honest, and/but err on the side of overstating your symptoms rather than understating. For example, if it is about a chronic condition and the doctor asks “are you able to do xyz”, take the question as meaning “are you able to do xyz on your worst days?”. You can clarify that if you like in your answer, but you need to include the information that xyz is something that your condition can and sometimes does impede you from doing.

Leave your embarrassment at the door. To the doctor (unless they are a very unprofessional one), you really are just one more patient with symptoms they have (unless your condition is very rare) seen a thousand times before. If your symptom is embarrassing, it will not faze them and you definitely should not hold back from mentioning it, for example. This goes extra in the case of discussions around sexual health, by the way, in which field the details you’d perhaps rather not share with anybody, are the details they need to adequately treat you.

After the appointment

Follow up on anything that doesn’t happen as promised (e.g. referrals, things ordered, etc), to make sure nothing got lost in a bureacratic error.

Get a second opinion if you’re not satisfied with the first one. Doctors are fallible, and as a matter of professional pride, it’s likely the second doctor will be glad to find something the first doctor missed.

See also: Make Your Negativity Work For You

Take care!