ach summer, a fresh crop of interns arrives for work, infusing hospitals throughout the country with a spirit of nervous excitement.

For nearly two decades, their grueling schedules have been a national concern, fueled by the fear that exhausted interns may be more likely to make dangerous mistakes.

And while the new doctors themselves worry initially about how they will survive the long days and sleepless nights, they soon discover that their most difficult challenge is learning how to cope with their continuous and unrelenting exposure to human suffering, suffering they are often unable to relieve.

By the end of their first year, most interns realize that the greatest threat to patient care comes not from the late-night loss of a resident's acuity, but rather from the progressive corrosion of a resident's humanity.

As students, we chose to enter medicine because we wanted to take care of patients, particularly during their times of greatest need. But residency training deliberately exaggerates and concentrates this exposure.

While most of the real work of doctoring occurs in the outpatient setting, residency training remains largely focused on hospitalized patients, an emphasis that teaches physicians how to manage a remarkable range of urgent medical problems.

Because an increasing amount of care now takes place outside the hospital, the patients who are actually admitted tend to be extremely sick, and they often carry dismal prognoses.

Walk around the wards, and you will see the pleasant middle-aged woman whose two months of belly pain turned out to be metastatic colon cancer. You will hear the elderly Italian man with diabetes and multiple limb amputations moaning "dolore, dolore" each time someone enters the room.

When you spend all your time in the hospital, you are overwhelmed by the awful power of disease.

How do you respond to the anguish on the face of a young man when he says his sickle cell anemia "feels like it's breaking my bones," or to the resolute bravery of two teenage sons helping their father through a relapse of stomach cancer?

As a resident, you also come to appreciate that for many people, the hospital is frequently not so much where a patient comes to be treated and cured, but rather a place of transition, a clearly demarcated point in a person's life trajectory where changes that may have accrued over months or years are recognized and acknowledged — often in heartbreaking fashion.

Many times, a hospital stay is the time when a patient realizes that he or she can no longer live independently, or the time when a person with a terminal illness decides to pursue hospice care. The opportunity to help guide patients through these profound, life-defining moments represents perhaps the most rewarding — and challenging — aspect of our medical training.

Surprisingly, within most residency programs, there is very little discussion of the challenges of coping with the suffering. When I asked several seasoned physicians about this, each advised me to ignore the misery and focus exclusively on learning the mechanical details of patient care. Empathy, I was told, could wait until residency was over.

I don't think so. What defines us as physicians is not just our ability to read EKG's, or to know what to give to a patient with chest pain or shortness of breath — important as these skills may be. It is also our ability to empathize with patients, to help them understand and come to terms with what may be a terrible diagnosis, and to assist them, spiritually as well as physically, as they move toward an often uncertain future.

As patients become sicker, the ability of doctors to recognize and respond to their unique concerns becomes an even more important component of the total medical care these patients receive.

To be sure, the answer to this problem is not to establish a new course for residents, or to specify yet another "core- competency" — heaven help us.

But perhaps if residents were able to spend a little more time outside the hospital and had more opportunities to talk with friends or family, to go for an occasional jog or hike, or even just to sleep, we might have a greater chance to understand and process what we are experiencing on the wards, enabling us to listen better, and to care more.

It's hard to imagine a more effective prescription — either for our patients, or for ourselves.