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November 14, 1977

On Encountering Hopelessness

JAMA. 1977;238(20):2179. doi:10.1001/jama.1977.03280210071031

Lisa Shulman's commentary (p 2149) is a pause or a time-out by a student (now Lisa Shulman, MD) in the midst of a demanding medical clerkship. As such, she shares with us a rare experience in clinical medicine. Caught up in the process of "doing," there is usually little energy or time left to pull back and integrate experience.

One realizes that there is something in this episode that touches a shared experience for all physicians. We are reluctant to acknowledge it, so the author does it for us. Our treatment of patients is greatly influenced by unexamined factors present within ourselves and is shaped by recent events in our lives and within the hospital. We are often confronted by the fact that "our reach exceeds our grasp," and in medical practice, given the intensity of expectations on all sides, this becomes a painful acknowledgment. Such disappointment often leads to