Suddenly, I was plunged back into an avid learning environment, starting at the bottom and working my way painstakingly up the mountain. The thrill of learning and accomplishing stimulated me so much that the work was pleasurable.

Empathy--the ability to identify with someone else's suffering--is certainly a prerequisite for a genuine apology.

The very fact that these doctors continuing to be doctors--highly successful ones--despite their errors and their accompanying assaults on their self-definion would itself be a potent lesson to the students and interns. It is possible to hold one's head up after an error, to admit that errors are part and parcel of human existence, even in medicine. It is possible to see the error as an aspect of oneself, not the defining characteristic of oneself.

Grief ate at these doctors, distracting them from both their families and their patients. Many reported withdrawing from emotional involvement with their patients and that their patients had noticed they weren't fully present.

Thus, whatever the medical student has been taught, and even genuinely believes, about the ideals of medicine, the primacy of empathy, the value of the doctor-patient relationship--all of this is swamped once he or she steps into the wards. [...] It's no wonder that empathy gets trounced in the actual world of clinical medicine; everything that empathy requires seems to detract from daily survival.

Fear is a primal emotion in medicine. Every doctor can tell you of times when she or he was terrified; most can list more episodes than you might wish to hear. [...] It may be sublimated at times, it may wax and wane, but the fear of harming your patients never departs; it is inextricably linked to the practice of medicine.

But I realized that not only did I need to keep tuning my skills as a doctor, I also had to figure out a way to live with the uncertainty of medicine and its attendant anxiety.

Burnout also leads to a large swath of physicians who aren't as empathetic toward their patients as they could be.

Empathy requires being attuned to the patient's perspective and understanding how the illness is woven into this particular persons' life. Last--and this is where doctors often stumble--empathy requires being able to communicate all of this to the patient.