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Neurologist Scott Abramson discusses his article “Why ‘the best physicians’ risk burnout and isolation.” In this YouTube-optimized episode, Scott reflects on the ancient Talmudic teaching that warns how pride and perfectionism can become a physician’s downfall. He explores how the culture of grit, self-sacrifice, and fear of vulnerability leads many doctors to burnout and emotional isolation. Drawing on decades of medical experience, Scott emphasizes humility, connection, and the courage to seek help when the weight of responsibility becomes too heavy. Viewers will gain insight into how physicians can protect their well-being, sustain empathy, and rediscover meaning in medicine by supporting one another.
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Transcript
Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome Scott Abramson. He’s a neurologist. Today’s KevinMD article is “Why the best physicians risk burnout and isolation.” Scott, welcome to the show.
Scott Abramson: Hey, Kevin. Good to be here.
Kevin Pho: All right, so you’ve been on multiple times. Tell us what this latest article is about.
Scott Abramson: OK, well first of all, the title is “Why the best physicians are destined to hell.” That’s an odd thing to say, right? But this is commentary in the Jewish Bible; it says these words, and it seems peculiar. But when you think about it, it makes sense because sometimes the best physicians are the most prideful or the most arrogant. When they don’t know something, they don’t realize it. If they do realize they don’t know something, their pride prevents them from asking for help. For that reason, they fail their patients, and for that reason, they’re destined to hell.
I can tell you, Kevin, there have been times in my life where I should have been asking questions to someone, but maybe I felt intimidated, or I felt I didn’t want to look stupid or incompetent. I didn’t ask the questions.
I think this works in another way, because as you know, I was active and one of the leaders in the physician communication and wellness projects at Kaiser. It works the other way because sometimes the best physicians are the hardest working, most conscientious, and they’re the ones that get most exhausted, physically and emotionally. What do the best physicians do then? They don’t reach out and ask for help. They do what they always do: They put their nose to the grindstone, they suck it up, and they pay the piper because when the going gets tough, we know what happens.
So in the article, what I said was that if you’re on this journey, on this pathway to be one of the best, that you’re going to be the best physician destined to hell, to reach out for help. Reach out to someone: a trusted colleague, EAP counselor, faith community, or a person. The other thing I said in there was, “And if you see one of your physician brothers and sisters heading on this path, don’t let them take the journey alone. Reach out to them.” In the closing article, I thought I was being clever and I said, “Friends don’t let friends become the best doctors.”
Basically, this was about doctors reaching out and also reaching out to our colleagues when we see that they’re going down the wrong path.
Kevin Pho: You mentioned earlier that there were times in your career where you were afraid to be vulnerable, where you felt held back from asking questions. Give us an example from your own story about times where you maybe didn’t ask a question where you should have.
Scott Abramson: That happened many times. Instead of going into some of the specifics, let me just say that as physicians, we have incredible power to affect how our colleagues feel about things and how they feel emotionally.
I remember once a young physician had started at Kaiser, and he said to me, “I had a patient in my office.” We have this system where if you have something that you’re wondering about, you can call someone on the phone while a patient is in your office and get an immediate response. That’s what he did. He called this orthopedic surgeon. He knew it wasn’t an ER emergency, but he just didn’t know what it was. He explained the problem. On speaker phone, the doctor said, “Well, you do this, this, and this.” Then the doctor said to him, “You didn’t really need to call me about this patient. Next time just Google it.”
Now imagine, you’re sitting there with a patient in your office, and what is this patient thinking? Can she trust her doctor? What is this doctor thinking? The next time he has a problem and has to call this specialist, he’s going to think twice about calling. He doesn’t want to be humiliated. What is he going to do? He is going to wait until the next day when Dr. Nice Guy comes on, and that guy’s going to be overburdened. It’s just this chain effect. Sometimes we can do so much to help our colleagues, but sometimes inadvertently we do things that do the opposite.
It’s this interaction between doctors that I was so interested in.
Kevin Pho: Why do you think that medicine still carries a culture of silence around emotional and mental health struggles?
Scott Abramson: I think, at least in my generation, that’s how we were brought up. You just suck it up. You pay the piper. You just do what you’re supposed to do.
I think that’s why so many doctors have what we call burnout or moral injury: because our values are that we’re going to do things right all the time. We always achieve; we produce. I had one colleague tell me that she was an “APM.” Do you know what an APM is, Kevin?
Kevin Pho: I don’t. What’s an APM?
Scott Abramson: An APM is an “Asian perfection machine.” You don’t have to be Asian to be an Asian perfection machine. We’re all brought up that way.
When we find that in our daily life our actions don’t match this value of being perfect and doing everything, it creates this dissonance. The only way we know to handle that is just to work harder, put our nose to the grindstone, and that’s it. We don’t reach out for help.
Kevin Pho: Have you seen a cultural shift towards the end of your career with the newer physicians entering the workforce? Do they have a different mentality?
Scott Abramson: I think they do. One of the things is that when I read the blogs, letters, and articles that come in, people have this platform where they are able to vent and let it out. When they do that, they read other articles about other doctors that are struggling, and it gives them this feeling of, “Hey, I’m not alone.” Even if it’s digital, they have fellow travelers that they can relate to. That’s why I think you are doing a marvelous job in that.
Kevin Pho: Why is it important for physicians not to be alone in that journey? When they meet those obstacles or feel burnt out, why is it important for others to commiserate in other stories?
Scott Abramson: Gosh, it’s just so important. It’s the human condition. When we’re feeling hurt, we want to reach out and tell others about our hurt. When we get the response back that, “Hey man, it’s not so bad.” Or, “Maybe it’s bad, but you know what, I’m sorry you’re feeling that way. I’m sorry you’re going through this. Gosh, it’s tough.” To get that. Number one, to be able to admit it. Number two, to express it to someone else to get it off your chest. Number three, if you can get a response back, maybe there’s no solution, but maybe the solution is just someone putting a hand on your shoulder and giving you a hug.
Kevin Pho: You mentioned that you worked in the wellness space when you were with Kaiser. Did you ask other physicians to ask for help, because sometimes it doesn’t come naturally to them? How did you get other doctors and your colleagues to ask for help when they needed it?
Scott Abramson: That’s a good question. We had a lot of programs at Kaiser. We developed a lot of programs. We had a mentorship program, a one-on-one mentorship program. We had offsites where people would go, and some of them dealt with marriage issues. Some of them dealt with burnout issues, and people could sit and discuss these things. We had Schwartz Rounds; we had balance groups. We developed many venues where people could talk to each other and were encouraged to talk to each other.
Kevin Pho: Tell us a story where someone initially would be hesitant to ask for help or lean on their colleagues, and maybe they made that change, and it appreciably helped them with their burnout in the profession. Is there a positive story you could share about a physician who has course-corrected?
Scott Abramson: Gosh, there are so many stories, Kevin. Let me tell you one. There was this physician, a cardiologist. He’d been at Kaiser for about 30 years. I was talking to him. He said, “You know, when I first joined Kaiser, I was like a lot of doctors. I was uncomfortable. I was unsure of myself, and I worked so hard to try to prove my worth.” He said it was tough, those beginning years. But he said there was one guy, a neurologist by the name of Sid Rosenberg. He said, “Every time that I ran into Sid in those first few years, he would always, maybe it was in the cafeteria, in the hallway, tell me he appreciated how hard I was working. He appreciated the quality of my consults.”
He said, “This was 30 years later,” and he said, “It’s 30 years later now, and I still feel so grateful for those words of encouragement from my colleague Dr. Rosenberg.” Sometimes a kind word and encouragement can go so far to make a difference in one’s career.
Kevin Pho: As you know, we talk a lot on this site. The state of our health care system isn’t making it easier for physicians. Tell us the type of advice you have for physicians who are currently practicing, or physicians who are just entering the workforce, about how they can ask for help or do the things that they could do to prevent burnout, based on this article and your reflections.
Scott Abramson: Here’s one thing, and this is more of a preventative thing. I know there’s a chief at Kaiser, and every so often on a regular basis, he will call one of his physicians into his office. Here’s what he’ll say. It’s real quick. He will say, “Dr. Jones, I called you into my office today. You have no patient complaints against you. There are no medical legal problems. Your patient survey scores are great. The reason I called you into my office to have this personal conversation is: Dr. Jones, you are doing one hell of a job. Keep it up.” That was the end of the conversation.
This is a proactive thing. “Come on in. Let me tell you…” How often does that happen? Here’s the other thing, Kevin: You don’t have to be a chief to do this. The guy in the next office, you could walk in his office and say, “I just want to tell you how much I appreciate all the backup that you’ve given me, the support you’ve given me. Thank you for being my colleague and my friend.”
Kevin Pho: No strings attached, right? I think just a simple interaction and encounter like that, because how often is it that you get called into an administrator or a leader’s office and it’s universally something bad, something critical, a patient complaint? A simple, positive encounter without any strings attached can mean a world of difference.
Scott Abramson: That’s right. You go home that day and you tell your wife and you tell your kids. You remember that, just like Dr. Ed Fisher remembered that encounter with one of his colleagues.
Kevin Pho: One of the things that you talked about in your article about the best physicians is that they are frequently isolated. Talk more about that and how they can find community. You mentioned things like faith, spirituality, and community. What are some of the things they can do, these best physicians, to feel less isolated?
Scott Abramson: Well, I’m going to turn it on its head, Kevin, and I’m going to say, what can we do as colleagues to help those physicians who maybe don’t reach out? What can we do? Again, it’s the same story. One of my colleagues was hardworking, one of the best physicians, and she was feeling broken down, beaten up, and just flat burnt out. She decided to leave Kaiser and leave medicine altogether. On the last day she was working, many of us came to her office and told her how much we enjoyed working with her professionally and how much we enjoyed knowing her personally.
At the end of that day, guess what she said? She said, “You know, if I would’ve known folks felt like this, I might not be leaving.”
Here’s the thing: Why is it that our colleagues have to be beaten up, broken down, and flat burnt out before we tell them how much we honor them as colleagues?
Here’s what we can do for our colleagues: Reach out to them. Tell them how much we appreciate them. No one ever does that.
Kevin Pho: We are talking to Scott Abramson. He’s a neurologist. Today’s KevinMD article is “Why the best physicians risk burnout and isolation.” Scott, as always, let’s end with some take-home messages you want to leave with the KevinMD audience.
Scott Abramson: Here’s one, Kevin. Again, it’s the same thing. As I mentioned, we worked in physician wellness and we have many programs. One of our people on our committee was a woman named Jackie Magnolia-Ska. This woman, she’s about five feet tall, but she’s a powerhouse. Physically, she’s a great athlete. She does this California Death Ride, a 120-mile ride in the mountains, and she’s a black belt in TaeKwonDo.
She decided she was going to do this project called the Spartan Race or something like that. People have to do these incredible things: They have to jump hurdles, they scale walls, they haul sandbags, they flip tires. It’s just an incredible thing.
So we said to Jackie, “Jackie, this is a great thing, but this may be a little bit too tough for some of our participants.” Jackie looked at us and said, “Don’t worry about it. Nobody gets left behind. I’ll make sure of it. Nobody gets left behind.”
If all of us looked at our colleagues and we saw them struggling, and we had that mindset, “Nobody gets left behind. Especially my colleague.”
Kevin Pho: Scott. Thank you so much for sharing your perspective and insight. Thanks again for coming back on the show.
Scott Abramson: Thank you, Kevin. I appreciate it.