This podcast episode features Dr. Phil Boucher and Dr. Marina Capella discussing the practicalities of setting and maintaining boundaries in direct primary care (DPC) pediatric practices. The conversation primarily unfolds through real-world case studies, illustrating how boundaries are defined, enforced, and how they can flex based on context and physician comfort levels.

Main Themes

* The concept of boundaries in DPC is not one-size-fits-all; physicians are encouraged to establish and respect their own boundaries tailored to their life and practice.

* Boundaries are positioned as personal guidelines for how providers respond to requests, not about changing patient behavior directly.

* Case studies deal with after-hours communication, appointment punctuality, handling alternative or online medical tests, and managing “over-communicative” or anxious parents.

Key Highlights

* After-Hours Communication: Phil and Marina discuss what they would do when receiving a late-evening text about a sick child. Each describes their thresholds for what is within their boundaries, such as handling situations over text or a brief call versus physically coming into the office. They stress giving actionable guidance to parents while also maintaining personal downtime and not feeling guilty for doing so.

* Flexible Yet Firm Boundaries: Instances where providing help after hours or in unorthodox setups (like meeting a parent in a parking lot) were discussed as examples of flexible, situationally appropriate boundaries—balanced by the clear statement that such actions are not always expected or required.

* Setting Expectations with Parents: Phil and Marina explore scenarios where parents miss or delay scheduled appointments. They emphasize the importance of being clear about availability and acceptable loss of appointment times, and the hazards of setting resentful boundaries due to over-accommodation, especially noting challenges faced by female physicians.

* Handling Non-Traditional Test Results: The increasing frequency of parents bringing in lab tests ordered online is discussed. Both hosts advocate for transparency about expertise, investigating legitimate tests, and compassionately guiding parents without judgment while warning that not all “alternative” tests are medically credible.

* Over-communication from Parents: Strategies are shared for managing parents who check in excessively, such as recommending logs, spacing communication, and scheduling feedback rather than replying instantly to every message. This helps “train” expectations and supports the physician-parent relationship without burnout.

Episode Summary

* Consistent Responses: Frequent, immediate responses train parents to expect 24/7 access, while delayed or scheduled responses help set realistic expectations and maintain provider wellness.

* Gender Dynamics: The doctors note that boundary issues can be compounded by gendered expectations, with women more frequently pressured to overextend; having a protocol and iteratively communicating limits is vital.

* Compassionate Framing: Even when saying no or limiting services, responses should be professional, kind, and indicate the physician’s desire to help within reasonable means.

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