Patience for Patients

On Burnout, Boundaries, and Being Human in the Therapy Room

Most new patients come to me with complex chronic illnesses, disabilities, and long, meandering medical histories. They’ve seen a dozen specialists with few answers or, worse, been dismissed and told their pain is “all in their head.” Just last week, a patient told me, “The providers do it for the business, not treatment. They don’t even listen to what has happened to you.” Variations of this sentiment echo across my caseload. Each day, I offer care from within the same systems that have failed me, too.

Patients describe the exhaustion of retelling their story, how each appointment reopens a chapter they never wanted to live in the first place. Their concerns are minimized, their symptoms rationalized away. Even when advice is offered, it’s often inaccessible - requiring money they don’t have, bodies they don’t inhabit, or support systems that don’t exist. They’re right: too often, the system wasn’t built to care. It was built to bill.

How do you offer care from within the very systems that have failed you?

As a disabled psychologist, I validate all of it. I get the anger, the exhaustion, the fear, the disappointment. I carry it, too. Especially for women, people of color, and disabled patients, being told their symptoms are imaginary, exaggerated, or drug-seeking is not an exception. It’s expected. My patients with sickle cell disease, for instance, often tell me how ER doctors ignore their pain crisis plans, even when they’ve been carefully developed by hematologists and worked in the past. They walk in prepared, only to be doubted and denied.

I validate how maddening it is to feel invisible in your own chart. How frustrating it is when vague recommendations like exercise more, get better sleep, or elimiate stress feel completely out of reach given caregiving demands, poverty, limited mobility, or unsafe housing. I validate the despair of being bounced from provider to provider, with no one willing to take on your care because it’s too complex, too rare, or not within their specialty. And I validate the devastation of discovering that the rare providers who are willing to help are often out-of-network, private-pay, or otherwise inaccessible.

None of it is okay. And it happens every day.

I also hold another truth alongside the fury: most doctors are people trying to do their best in broken systems. Many don’t have time to read full histories, much less obtain them. Hospitals make coordinating care across specialties nearly impossible. Offices are short-staffed; follow-up calls fall through the cracks. Longer appointments aren’t reimbursed. Even when doctors do have time, they often don’t have the answers. They want to help, but they don’t always know how.

Doctors, too, are caught in systems that prioritize business needs over patient care. I’ve seen physicians pressured to prescribe medications, recommend surgeries or implants, and rush patients through visits to meet productivity targets. The result is that compassionate, timely, relationship-centered care that accounts for the whole person - their lifestyle, values, finances, and goals - becomes a luxury rather than the norm.

Over time, this disconnect breeds moral injury: a deep psychological distress that arises when professionals are forced to act in ways that violate their ethical or moral code. Providers are pushed to practice in ways that contradict their training and values. They’re demoralized. And it shows.

In navigating this dual perspective, provider and patient, I’ve come to ground my work in a foundation deeply shaped by disability studies. I don’t practice from a model that seeks to cure. Instead, I work from social and cultural models of disability that ask how we can reduce barriers, increase access, and build lives worth living. Not by erasing disability, but by honoring complexity and supporting interdependence. My clinical approach draws from pain psychology, evidence-based practices such as CBT and ACT, and the science of emotion regulation, while holding space for the grief, rage, and longing that patients often carry.

From that foundation, I teach patients (and remind myself) to navigate care with mindfulness, boundaries, and self-advocacy. I help them identify their values and figure out how to engage with the medical system in ways that align with those values, as much as the system allows. I support them in finding trustworthy providers and making peace with what the system can’t provide. I encourage balanced skepticism: a willingness to ask questions, push back, and seek second or third opinions when something feels off. We discuss preparing for appointments, bringing support people, and leaning on the community for both validation and logistics. I support care paths that reflect patients’ cultural values and lived experience, even when they fall outside the dominant medical model.

I practice what I preach. I carry the intention, the training, the tools. And still, I make mistakes.

Sometimes I don’t read recent chart notes before a session. Sometimes I don’t have time to consult with treatment teams. I want to offer integrated, wraparound care, but some days, there just aren’t enough hours. The gap between the care I believe in and the care I can offer is often its own heartbreak.

I, too, am constantly disappointed by the system. And the emotional weight of it gets to me, in big and small ways.

I get triggered. When I’m told no doctor has ever cared, while I’m sitting right there, caring deeply. When life with limitations is dismissed as unlivable, while I help people build lives full of meaning every day. When mobility aids are seen only as failure, while I see them as access and agency.

These moments hit hardest when I’m over capacity. And lately, I’ve been over capacity.

Like many in academic medicine, I’m navigating rising clinical demands as research funding shrinks. The pressure to do more with less is relentless. When my empathy wears thin, I try to notice. I walk the dog. I cuddle my toddler. I eat take-out sushi. I vent to friends. I remind myself why I do this work.

And still, even when I’m rested, I have to decide on the fly how to respond when patients say things that are ableist, sexist, or cruel. A few months ago, a patient called me fat (not in a descriptive or fat-positive way, but in a derogatory, shaming one). That same session included both racist and ableist slurs. My job is to care, not correct. But I have to protect myself: my energy, my identity, my boundaries. Every session becomes a negotiation. When do I gently educate? When do I let it go? When do I name harm?

There is no manual. No easy answer.

What I know is that it’s not that I don’t care. It’s that I care deeply, so deeply it hurts. So deeply I have to protect the part of me that allows me to keep doing this work.

Sometimes I speak up because it’s clinically important. Other times, I speak up because all people deserve to be treated with dignity. That calculation of when to intervene or when to stay silent is its own exhausting calculus.

This is the paradox of being a disabled provider: providers are patients, too. I live in the same systems as my patients. I know the pain not just intellectually, but viscerally. I feel it in my own body, my own appointments, my own battles with bureaucracy. I hear it in my patients’ stories too: the months-long waitlists, the rushed ten-minute visits, the notes that misrepresent symptoms, the plans that ignore context. The referrals that go nowhere. The insurance that says no. The patient messages that go unread.

I carry my experience. I carry theirs. And I wish I could fix it for all of us.

I want systems that recognize our worth, our complexity, our pain. Because when it works and when care is collaborative, humble, and human, it is transformative.

A patient recently said to me, “I never thought of asking for help as strength before.” Another said, “This is the first time I’ve had a provider who gets it.”

That’s it. That’s the heart of it.

There’s a metaphor I come back to often. Life is a juggling act. Some balls are rubber. Some are glass. The rubber ones bounce. The glass ones shatter. I’m trying to tell the difference and protect what matters most.

I drop the pressure to be endlessly patient when I’m being harmed. I drop the urge to fix what’s beyond my control. I drop the expectation that I can carry others’ suffering without it ever touching me.

And I try to protect the glass: the part of me that believes in people and loves this work and knows what it means to show up broken and still offer care.

That’s what I hope to model in the therapy room - not perfection or detachment, but presence and humanity. A reminder that none of us are machines and healing doesn’t require certainty, it requires connection.

I can’t fix broken systems alone. But I can offer trauma-informed, evidence-based care grounded in relational presence and cultural humility. That’s my work: to hold both the science and the heart of therapy.

That’s the glass I’m trying not to drop.