We, as doctors, are trained to help patients. Starting from days in medical school, most of us have adopted an attitude to study hard. After graduation, working hard is still the norm for many clinicians, possibly because of the need for post-graduate examination, more needs from our patients and perhaps an inborn habit of many. We issue sick leave certificates to patients whenever indicated every day as part of our job, but many doctors seldom take sick leave themselves when they become sick. This is true both in the public and the private settings, owing to the heavy workload or lack of a doctor replacement.

Are doctors supermen/superwomen or are they immune to sufferings which in general all human beings have? Entry into medical school is highly competitive worldwide, studying hard is a must in the medical school, and working hard after graduation is expected by our colleagues, patients or even us. I understand that many doctors are high achievers, but it does not mean they are more fit than others both physically and mentally. It is well known that doctors have higher suicidal rate, depression and other health-related problems.

Frankly speaking, we are more vulnerable than the ordinary population. Doctors tend to treat themselves and have very poor compliance into taking medicine and follow-up, the objectivity in management is sometimes lost and unsatisfactory outcome more easily sustains. There is an old Chinese saying "one can treat others perfectly well but cannot treat himself/herself". Many old Chinese sayings are true and this one is of no exception, I believe.

Many a time, we advise patients to relax and do more exercises, even though many of us cannot do that ourselves, because we are always busy, which seems to be a very good and convenient excuse. However, we keep persuading our patients to do this and that. Is our advice practical? Do we believe in what we try to convey to others? Some doctors do have time to relax and do exercises, but they tend to do "the most relaxed ones" or which give the most relaxation within the shortest time. There is always a competitive element that accompanies the exercise.

The life of a doctor can be very stressful; handling of life and death alone is already causing enough stress, not to mention stress from his or her own expectation, expectation of patients, family and community as a whole. The recent increase in complaints and litigation cases against doctors adds burden to us as well, the good thing is that we become more alert and conscious of the quality of our practice, although from time to time there may still be the unwarranted complaints, the majority of which are mainly due to communications problems.

Hong Kong people had a hard time in the past few years, doctors were of no exceptions. Doctors, especially the junior ones, had increasing stress from living with uncertainty, unreasonable demands, long working hours and meeting heart-sink patients. The interaction between the demanding nature of our work and within us the obsessive, conscientious and committed personality predisposes us to more physical and mental problems. If adjustment is not made, and the stress continues, doctors may end up with becoming burnout which is a syndrome characterized by emotional exhaustion, depersonalization and a lack of personal accomplishment, leading to diminished performance, fatigue and insufficiency.

According to Figley's definition, burn out is physical, emotional and mental exhaustion caused by long term involvement in emotionally demanding situation.¹ The long working hours and not taking value in what we are doing definitely and greatly increase the risk. This is a very debilitating condition and once it is established, it is next to impossible to treat. Therefore, be on the alert of this condition and prevention of its occurrence is most important.

How to prevent this problem? This can be discussed under 3 aspects, namely personal, professional and organizational.²

Personal - we must set realistic goals in life and have good time management. Respect our own limits and do not push ourselves too much to do several tasks simultaneously. Remember to do sufficient regular exercises and give us a break from time to time, as you will probably work for at least 30 years more if you are now in your 30s, thanks to the delayed retirement age and the prolongation of life expectancy. Having good communication skills can never be more emphasized as interactions with other people, including patients, colleagues, friends, relatives, all affect our mood to certain extent. Developing a humorous character is protective against burnout. Humour medicine can help patients, and at the same time, help doctors themselves as well. Develop other interests and hobbies to enrich your life, healthier doctors are those who maintain a passion outside medicine even at the expense of salary. Further, learn to say no and decline any extra-work which is beyond our capacity, appropriate degree of assertiveness is protective and essential for us to survive.

Professional - remain updated and stimulated in the practice of medicine. Learn new skills and knowledge, and participate in various seminars and medical conferences, local or international; these are good chances to exchange opinion and experience. Many solo doctors find themselves quite professionally isolated. I find regular small group discussion can help to solve this helpless situation.

Organizational - we can develop the practice pattern suitable to ourselves, e.g. have separate sessions for walk-in cases and follow-up clinics. For those working in the private sector, we can develop special interest and provide new types of services. We can also collaborate with universities to teach medical students and do research.

In order to keep the fire burning, we must have good health. Dear colleagues, work hard, play hard and please enjoy life.