This is a famous teaching in the Talmud, which in the Jewish faith is the commentary on the Hebrew Bible. Why would the holy book of the Jews make such a proclamation? It turns out this is about arrogance. It is about humility. The “best doctors” may also be the most prideful. Their arrogance may prevent them from realizing they need help. If they do realize it, their pridefulness may prevent them from asking for that help. For this, “the best physicians” may fail their patients. For this, they may be destined to hell.

I believe there is truth in this. Most of us have had moments in our professional lives when we have not asked questions or reached out to colleagues for fear of looking unintelligent or feeling incompetent. I know I have been guilty of this. Mea culpa.

This teaching may also be true in another way. We, “the best physicians,” may be the hardest working and the most conscientious. When we suffer from physical and emotional exhaustion, we may not reach out. We do not ask for help.

For many of us, the story of our professional lives is this: We face overwhelming workloads, long hours in the hospital, and even more hours at home with our hospital computers trying to finish the day’s work. We spend countless, frustrating hours doing clerical work that a medical secretary should do. We cancel dinner dates with spouses and friends. We miss our children’s soccer games and music recitals.

In the face of this overwhelming pressure, what do we do? How do we respond? Most of us do what we always have done. We put our heads down and work harder. We plow through. We endure because “when the going gets tough …” (you can fill in the blank). We are made of grit, backbone, pluck, and spunk. We are not quitters. We bite the bullet, swallow the pill, and pay the piper. We do all this, but we do not ask for help. We persevere in silence.

While we may tough it out, our flame of resilience grows dimmer. We feel something is not right. We wonder when we look in the mirror if we are seeing the charred face of burnout.

If there is a kernel of truth in this for anyone, please reach out to someone: a trusted colleague, a physician well-being committee member, the employee assistance program, a psychiatrist, or a counselor in your faith community. Someone.

Maybe the “best physicians” are destined to hell. But if you, my physician brothers and sisters, feel like you are headed toward this destination, please heed this warning: Do not take this journey alone. If you see your fellow physician brothers and sisters heading down this path, reach out to them.

Remember: Friends do not let friends become “the best physicians.”

Scott Abramson practiced neurology with Kaiser Permanente Northern California for over 40 years, from 1979 to 2020. Throughout those years, Dr. Abramson was passionately involved in physician communication and physician wellness endeavors. Some of his insights and stories from his experiences in these endeavors can be found in video format on his YouTube channel, Doctor Wisdom. He is also the author of Bedside Manners for Physicians and Everybody Else: What They Don’t Teach in Medical School (or Any Other School).

While retired from neurology, Dr. Abramson remains actively engaged in physician communication and physician wellness pursuits. He has conducted numerous workshops in these areas and has personally coached many physicians. He has developed programs on time management, physician-patient communication, marriage in medicine, burnout, the threatened physician, difficult conversations, storytelling, and his favorites: “The Secret of Happiness” and “What The Great Wisdom of Country Music Can Teach Physicians.” He takes pleasure in delivering talks on these and other subjects.