Go to this post by Dr. Jeffrey Parks who blogs under the name "Buckeye Surgeon".
He write about the endless demand for excellence and quotes Cicero who said:
"For the better he is at his job, the more frightened he feels about the difficulty... about its uncertain fate... about what the audience expects of him."
Back though the years perhaps there was a time of the "complete internist", before the economic hegemony of the third party medical payers divided internists into officists and hospitalists,when the general internist shared similar frightening challenges that the surgeon from Ohio writes about so well. This was time when the internist was not a competitor of the NP , PA and family doctor. (no, I do not equate the family physician with the two categories of "physician extender"). The challenge of the complex, critically ill patient was parallel to the challenge that the general surgeon faced with a "tough case". So today far fewer general internists do that sort of thing as they are relegated to the office and juggle guidelines for routine management of standardized problems and inquire about seat belt use,and flossing and offer wellness to the worried well in the form of various preventive measures .
I began to sense the endless demand for excellence in medical school in the clinical years.You could never know too much.Something you did not learn or did not do could result in a catastrophic for someone entrusted to your care. There seemed to be endless demands. It seeemed like too much was expected.