The Optimized Doctor

Time for a rest


“More than Jews have kept Shabbat, Shabbat has kept the Jews.” – Ahad Ha’am

You should all be well rested by now. After all, we’ve just come through the festive shutdown of the holiday season where all of your pumpkin/peppermint/marshmallow flavored coffees were sipped while walking around in your jimjams at 10 a.m. It was the time of year for you to take time off to get a proper rest and be energized to get back to work. Yet, I’m not feeling it from you.

So let’s talk about burnout – just kidding, that would only make it worse. “Burned-out’’ is a hackneyed and defective phrase to describe what many of us are feeling. We are not “destroyed, gutted by fire or by overheating.” No, we are, as one of our docs put it to me: “Just tired.” Ah, a much better Old English word! “Tired” captures it. It means to feel “in need of rest.” We are not ruined, we are just depleted. We don’t need discarding. We need some rest.

Dr. Jeffrey Benabio, director of Healthcare Transformation and chief of dermatology at Kaiser Permanente San Diego.

Dr. Jeffrey Benabio

I asked some docs when they thought this feeling of exhaustion first began. We agreed that the pandemic, doubledemic, tripledemic, backlog have taken a toll. But what about the burden of paperwork and prior authorizations? Or the insanity of patients sending us emails through the night? EMRs? The consumerization of medicine? All factors, but not the beginning. No, the beginning was before paper charts. Well, actually it was before paper. We have to go back to the 5th or 6th century BCE. That is when scholars believe the book of Genesis originated from the Yahwist source. In it, it is written that the 7th day be set aside as a day of rest from labor. It is not written that burnout would ensue if sabbath wasn’t observed; however, if you failed to keep it, then you might have been killed. They took rest seriously back then.

This innovation of setting aside a day each week to rest, reflect, and worship was such a good idea that it was codified as one of the 10 commandments. It spread widely. Early Christians kept the Jewish tradition of observing Shabbat from Friday sundown to Saturday until the ever practical Romans decided that Sunday would be a better day. Sunday was already the day to worship the sun god. The newly-converted Christian Emperor Constantine issued an edict on March 7th, 321 CE that all “city people and craftsmen shall rest from labor upon the venerable day of the sun.” And so Sunday it was.

Protestant Seventh-day denomination churches later shifted sabbath back to Saturday believing that Sunday must have been the Pope’s idea. The best deal seems to have been around 1273 when the Ethiopian Orthodox leader Ewostatewos decreed that both Saturday AND Sunday would be days of rest. (But when would one go to Costco?!) In Islam, there is Jumu’ah on Friday. Buddhists have Uposatha, a day of rest and observance every 7 or 8 days. Bah’ai keep Friday as a day of rest and worship. So vital are days of respite to the health of our communities that the state has made working on certain days a violation of the law, “blue laws” they are called. We’ve had blue laws on the books since the time of the Jamestown Colony in 1619 where the first Virginia Assembly required taking Sunday off for worship. Most of these laws have been repealed, although a few states, such as Rhode Island, still have blue laws prohibiting retail and grocery stores from opening on Thanksgiving or Christmas. So there – enjoy your two days off this year!

Ironically, this column, like most of mine, comes to you after my having written it on a Saturday and Sunday. I also just logged on to my EMR and checked results, renewed a few prescriptions, and answered a couple messages. If I didn’t, my Monday’s work would be crushingly heavy.

Maybe I need to be more efficient and finish my work during the week. Or maybe I need to realize that work has not let up since about 600 BCE and taking one day off each week to rest is an obligation to myself, my family and my community.

I wonder if I can choose Mondays.

Dr. Benabio is director of Healthcare Transformation and chief of dermatology at Kaiser Permanente San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Dr. Benabio is @Dermdoc on Twitter. Write to him at

Recommended Reading

Ten recommendations for building and growing a cosmetic dermatology practice
MDedge Dermatology
All the National Health Service wants for Christmas is tea and biscuits
MDedge Dermatology
A doctor saves a drowning family in a dangerous river
MDedge Dermatology
Problematic alcohol use on the rise among physicians?
MDedge Dermatology
Medicare pay cuts partly averted in massive budget bill
MDedge Dermatology