Rehab for doctors should be an institution. Not the least colleague made use of it after all, even several times: our all time big hero Dr. House. Didn’t we all, the good and eager med students, at some point want to be like him? If everybody failed, he always got it right. He was a genius, a broken man, an asshole and a hero. The clinical personification of text books, motivational  for his students and untouchable for anyone. His patients tended to have a strong aversion at first sight, but deep inside his soul resided the good. He was not evil, it just did not always show. Anyway they always loved him once he found the ultimate solution of cure for their nearly dead close-one. This is what we long for. Obviously. It might be a TV-scheme, but actually it is not that far from reality.

Let’s have a closer look at Dr. House. Is he cynical? Quote: “We are selfish, base animals, crawling across the Earth, [but] because we got brains, if we try real hard we can occasionally aspire to something that is less than pure evil. “. What about empathy for patients? (btw I found one from Homer Sympson as well ” Just because I don’t care doesn’t mean I don’t understand. ” ) Does he seem stressed? No, a bit impatient maybe. But he is always easy and on top of things. Wait is that due to vicadin? No that is just for his leg pain, right?! What about somatisation?

Burnout is described as a chronic stress syndrome resulting in a form of depression. I know it is not officially recognized by DSM V, but it does reflect in ICD 10 (Z73). In the sense of definition and probable pathophysiology one might fit it more into the PTSD spectrum. Symptoms include signs of physical and emotional exhaustion, cynism and detachment, ineffectiveness and lack of achievement, increased drug abuse and problems sleeping. Especially people with an avoiding coping style seem to be at risk.

We tend to be overachievers most of the time, even though we might not yet be Dr. House. We finished school with unusually high marks to even get into med-school. And although we always pretended we were so passionate about studying, most of us surely felt a certain amount of pressure. All that was not too bad until it came to internships and oh god residency. All of a sudden you come to sit in between chairs. You have to please your boss and the patient. And you probably have to do that for at least 12-24 hours, while still answering a stream of phone calls every 5-10 minutes delivering another task.

Physician burn-out rates are on the rise according to a 2014 study by Mayo-clinic. Overall they found burn-out symptoms in around 50% of US physicians, using validated measuring instruments. There are lots of causes of this problem. Not the least that health care is more and more focussing on money and does not stroke with ethical values. The work pressure is often high, work-life balance fails, families break. At the same time, society changes. Often things do not fall in place.

Emergency medicine has the highest rates of these symptoms. There might be a post-traumatic component too. It is often not easy to deal with situation you have to handle. You see terrible things, people in pain, dying, reanimation. All your responsibility. How many of us have not been in a situation where you feel powerless and loose your sleep at night? It can be pretty close to war in an E.R.. And yes, we all say, we get used to it. But are we not avoiding to deal with it? Isn’t it just easier to shut down your soul, get cynical and just rotate around?

So maybe take a step back for a while and get some rest in rehab voluntarily before you end up treating your leg with vicadin and buying a stick to walk. Even though it is generally not a cool subject for doctors, you can help people a lot. Think about the stroke patient learning to handle his life. Or the young boy caught in an accident, starting to walk again. At the same time, often you can live in the mountains or even on the coast. Imagine to stroll through the dunes at 5 pm and get your surfboard ready after work every day. Why do we tend to make ourselves so miserable?

In Germany you can do some rehab work in several specialties and still make it count for your specialisation. Go, go, go. Relax, open your mind and surf the waves!

Or read about the medical content of his diagnoses in this book: Housemedizin: Die Diagnosen von “Dr. House”