The Best Physicians Are Destined to Hell


Scott Abramson, MD1

Perm J 2019;23:18.315 [Full Citation]
E-pub: 08/08/2019


Physician burnout is real. But the solution involves courage—the courage to look inside one’s heart and the courage to ask for help.


“The Best Physicians are destined to hell.” This is a famous teaching in the Torah, the Jewish holy book. Now why would the holy book of the Jews make such a statement?

The answer, the rabbis explained, is this is a lesson about arrogance—and this is a lesson about humility. “The Best Physicians,” as we all know, may also be the most prideful. They may not realize they need help treating their patients. And if they do realize it, their hubris, their feeling of self-importance, may prevent them from asking. For this, they fail their patients. And they fail themselves.

In this teaching there may be truth. I think most of us have had moments in our professional lives in which we have not reached out to colleagues for fear of appearing ignorant or of feeling incompetent. Of this, I know I have been guilty.

But this teaching may be true in another way. Sometimes when we, “The Best Physicians,” are suffering from emotional exhaustion, when we have lost the feeling of satisfaction in our daily work, and when we are staring burnout in its charred face, we ourselves, “The Best Physicians,” don’t reach out. We don’t 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 portable medical computers (my “Laptop Lover” is what my wife calls mine). We spend countless, frustrating hours doing clerical work that a medical secretary could do. We miss dinnertime with our loved ones. We miss bath time, bedtime, and reading time with our children. We miss their soccer games and their music recitals. But in the face of this overwhelming pressure, what do we do? How do we respond? Most of us, “The Best Physicians,” do what we have always done. We do what our years of training dictate we do—we put our heads down and work harder. We plow through. We suck it up. We tough it out because “when the going gets tough” (you can fill in the ____). We are made of grit, backbone, pluck, and spunk. We are not quitters. We bite the bullet, swallow the pill, pay the piper. We do all this, but we don’t ask for help. We persevere in silence. And while we may tough it out, our flame gets dimmer. We, “The Best Physicians,” may begin to see (or maybe we don’t see) the beginnings of burnout.

No doubt, the potential solutions to burnout are myriad, from paleo dieting to mindfulness to gratitude journaling to goat yoga (just to name a few). However, this commentary is not about those kinds of solutions. It is instead about a more primal solution: The solution that demands, before all else, we reach deep into our souls, acknowledge our physician angst, overcome our professional pride, and have the courage to accept from others support and guidance.

So, if there is a kernel of truth in this narrative for you, please reach out to someone: Your physician well-being committee, a psychiatrist, a counselor in your faith community, a trusted colleague, a loved one. Someone.

Maybe “The Best Physicians” are “destined to hell.”  But if you, “The Best Physicians,” my colleagues, are headed toward this destination, please heed this warning: Do not take this journey alone.

And if you see your fellow physicians heading down this path, think about lending a helping hand, a warm shoulder, or a listening ear.

Remember: Friends don’t let friends become “The Best Physicians.”

Disclosure Statement

The author(s) have no conflicts of interest to disclose.

How to Cite this Article

Abramson S. The best physicians are destined to hell. Perm J 2019;23:18.315. DOI:

Author Affiliations

1 Department of Neurology, San Leandro Medical Center, CA

Corresponding Author

Scott Abramson, MD (

Keywords: best physicians, destined to hell, holy book in Judaism, the best physicians, the Torah


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