The experience most interns have on day 1 is a massive increase in responsibility and work load as compared to medical school. Whereas most medical students in their 4th year "manage" (under the very close supervision of residents) 2, 3, or maybe 4 patients, on day 1 of intern year they are suddenly expected to be responsible for upwards of 10-12 patients (under supervision, but considerably less supervision than med students). Interns go from spending most of their time studying and learning medicine, to being suddenly, constantly busy with often mind-numbing tasks. We interns joke that we are nothing more than secretaries, doing tasks for our boses all day without time to sit down and think for ourselves, despite the M.D. we just spent years earning. Eventually, we get better at prioritizing, we learn the system, and we learn by doing.
But, early in intern year, we can't prioritize, we don't know the system, frankly we can't even keep which patient is which straight in our heads. But, regardless, we still have n number of tasks to do by the end of the day.
Spending extra time talking to patients isn't part of n. Empathy isn't an item in n. Figuring out a patient's priorities for their health aren't an item. Those are extras.
And to get home on time, after my 12-14 hour shift, all I have to do is my list of n tasks, which is substantial. So, we quickly learned that long conversations with patients are the enemy of getting home on time. And pretty quickly, we start to eliminate those conversations. Then, we figure out that other things patients need, like empathy, a careful history taking and detailed physical exam, family discussions, etc also stand in our way of getting our work done on time.
Eventually, we learn the ability to keep our patient's complex medical problems straight and become much more efficient at getting our work done quickly. So, realizing we have more time, some of us go back and start to do the things that really matter to patients, like those things listed above and in the article. But, we've already learned, or forced by the system to learn, that we can get away with not doing those things, so as soon as we get a little extra busy or are a little extra tired, those are the first things we skip.
Then, suddenly, we start second year and can now be asked to work 24-28 hours straight, and now we have 18-24 patients instead of 10-12 that we are responsible for and the system again drains us of the very thing we enrolled in medical school to be.