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Then you can just say goodbye to any chance of observing the child’s development or listening to the heart or the lungs. The person the medical students were going to interview was the grandmother of a ten-year-old girl who was in the pediatric intensive care unit, or PICU. In pediatrics, a patient interview often means a parent interview. You always talk to the child if the child can talk, but this child couldn’t talk; she had been in a catastrophic car accident and remained in a coma. I wanted the students to get a sense of the life her grandmother was living.

It was a course on the relationship between the physician and the patient, and the first part would focus on talking to patients. Four of these firstyear students would be my tutorial group; we would meet every couple of weeks and together the five of us would sit down with a patient—a hospitalized patient, a clinic patient, any willing patient I could find. The students would ask questions, and then it would be my job to go over the whole interaction with them—what had they asked, what had they learned, what had they understood.

I started this letter by considering you as the patient— anxious, drinking too much coffee, obsessing over your e-mail, having trouble sleeping, dreaming of white coats and stethoscopes. And as we consider your case, we imagine hands popping up around the room as eagerbeaver medical students comment on the symptoms, the diagnosis, and the management. Avid to use medical jargon, one student comments that this illness is iatrogenic, a word that means an illness caused by the medical profession. Iatrogenic infections, for example, are the ones that patients acquire in the hospital, or as a consequence of medical procedures.