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.

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.

How the sadness is handled by the physician has a powerful impact on the medical care received by the patients. If the grief is relentlessly suppressed--as in Eva's experience during residency--the result can be a numb physician who is unable to invest in a new patient. This lack of investment can lead to rote medical care--impersonal at best, shoddy at worst. At the other end of the spectrum is the doctor who is inundated with grief and can't function because of the overwhelming sorrow. Burnout is significant in both these cases, and that erodes the quality of medical care.

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.

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

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.

In general, empathy is easier the more we can identify with someone. When we can genuinely envision ourselves in a situation, it's possible to intuit what that person's suffering might feel like.

It can be rough going to maintain both composure and empathy in these situations, but a doctor's failure to do that is probably the number one reason why patients feel dissatisfied with their physicians and end up doctor-shopping endlessly.

But while the patient does bear some responsibility, I believe that the onus falls more heavily on the doctor to be attuned to the factors--cultural, ethnic, or just personal style--that influence how patients present their symptoms.

Hospital life--with its byzantine array of moving parts layered atop the unpredictable rhythms of illness--is a permanent state of flux.

What these older physicians exhibited is termed clinical curiosity. They stroke to understand their patients in order to elucidate the underlying medical conditions. This thoroughness, patience, and dogged curiosity may have been ingrained in them because they trained at a time when they were no rapid CTs or MRIs. But even now, when these diagnostic tools are at their fingertips, these physicians maintain this approach to patients, one that serves to appreciate the dignity and uniqueness of each patient and his or her illness.

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.

But at the most basic level, doctors need to be able to come forward with their errors and near-misses, otherwise we will never know where the problems lay.

Neuroscientist Antonio Damasio describes emotions as the "continuous musical line of our minds, the unstoppable humming." This basso continuo thrums along while doctors make a steady stream of conscious medical decisions.