Aoun's description of his illness with the acquired immunodeficiency syndrome [1] and Southwick's vignette [2] cogently put into words my own troubling experience as a fresh-out-of-fellowship attending that led me to lose interest in academic medicine, which originally held such promise and excitement. One of my mentors during fellowship training told me that I was not focusing enough on the clinical care of patients. Focusing resulted in noticeably improved outcomes and improved clinical skill. My enjoyment of clinical medicine and taking care of patients grew as never before.

Subsequently, I took a position at a prestigious institution in anesthesia and critical care. After two residencies and three fellowships, I was competent enough not to have to worry about the clinical aspects of my practice, and my thoughts turned to investigating new techniques in my specialty and new approaches to old problems. I remember how excited I was and how I felt there was so much work to be done. Before a year was out, my initial enthusiasm deflated. I witnessed attendings and residents who administered care by rigid protocols (thus avoiding having to spend time at the bedside). In the intensive care unit, the attending and residents rounded quickly from the foot of the bed, checked the flowsheet, looked at the numbers, and then moved on to the next bed and to other matters, rarely taking a few moments to just stop and look at or talk with the patient. Care of patients based on qualitative clinical indices and "just looking at the patient" was virtually prohibited by all the blood gases, mechanics, and other measurements required by protocols. My own efforts to render care carefully tailored to each patient's needs and to spend many hours at a patient's bedside were thought bizarre. The care of individual patients is fleeting; the greatest tragedy is that we are bringing up a generation of physicians who have no idea how to pay attention to, examine, and comfort patients.