If only we all had the opportunity to establish long-lasting and meaningful relationships with patients on a daily basis! Certainly, few patients today would say that their physicians connect with them, explain things clearly, and take the time to get to know them. As Co-Chair of the Society of General Internal Medicine's Task Force on Career Choice, I have spent years asking medical students why they are no longer interested in careers in internal medicine [1, 2]. The reason given most often is an inability to establish meaningful relationships with patients during medical training. The students ask us to increase outpatient exposure to correct this problem.

Thus, Dr. Burns' perception may depend on location. The outpatient-based physician will usually connect with his or her patients over the years. However, I remember when I was a medical house officer and would work all night to restore a desperately ill patient to health. In the morning, the private physician would walk in and the patient would glow at his doctor and say how happy he was to see him. I would feel left out of that "connexional" [3] energy.

The in-hospital training environment is toxic to good relationships. Patients enter desperately ill and leave after a diagnostic-related group-determined, foreshortened length of stay, long before a house officer, student, or attending physician can establish a relationship with them. Being the "attending of the month" on the wards (as I was with Mrs. Tyler) leaves one particularly vulnerable to this situation. To recapture students' (and perhaps our own) interest in internal medicine, we will need to either alter this environment or put students in physicians' offices, where they can see patients in a longitudinal manner and establish the relationships craved by those of us who chose internal medicine [4].

I agree that it was "unfortunate" for my student that this should have been one of his most "powerful experiences during medical school." But it was, and we must not let that remain the case. Courses such as the one run by Dr. Mack Lipkin at New York University (eloquently described in Anna Quindlen's recent New York Times article [5]) will help many of us learn how to restore medicine to the personally connected profession described by Dr. Burns. Because many physicians fear that health reform, with its emphasis on managed care and "business-like medicine," will further endanger the doctor-patient relationship, we must insist that this relationship be the core of medical practice and that sufficient time in the office and at the bedside must be allowed for it to flourish.