Many, many factors account for physician burnout and cynicism in different specialties, including lifestyle, geographic area of practice, private versus hospital practice, and so forth, and I will continue to write about this because it can affect patient care. But among the many factors involved, I do think that the patient population one deals with affects the feelings a physician has toward the patient. After all, it is much harder to sympathize with those who have made mistakes and poor decisions than with those who are only a victim of circumstance.

The job of the physician, and the art of medicine, involves trying to put aside the idea of the culpable adult or the blameless child and to treat the person as he or she stands before the doctor. This is incredibly difficult, but I suspect this push and pull is integral to the imperfect system that we have — a system that deals with human beings and human relationships as well as with science.