MVJ Medical College & Research

Hospital
Department of Pathology

AETCOM Module 2.4

2.4A : Demonstrate the ability to work in a
team of peers and superiors.
2.4B : Demonstrate respect in relationship
with patients, fellow team members, superiors
and other health care workers.
 Questions and Answers
Module 2.4 Working in a healthcare team
Q. What is a team? What isa healthcare team? What are the types of teams?
Team: Ateam is defined as a group of people who perform interdependent tasks to work toward
accomplishing a common mission or specific objective. Ateam can be defined as a distinguishable
set of two or more people who interact dynamically, interdependently and adaptively towards a
common and valued goal/objective/mission, who have been assigned specific roles or functions to
perform.
Healthcare teanm: Health care team means 2 or more health care professionals working in a
coordinated, complementary and agreed-upon manner to provide quality, cost-effective, evidence
based care to a patient.
Types of teams: An early and influential classification was offered by Sundstrom and colleagues
(1990), who proposed 4 categories: (a) advice and involvement teams (eg. Quality improvement
team, which serves to recommend process changes in a healthcare practice or hospital and to
engage people in making the changes successfully), (b) production and service teams (eg. Allclinical
teams), (c) project and development teams (eg. Electronic health records team), and (d) action and
negotiation teams (eg. Health system executives and attorneys seeking a merger with another
system).

Q. What are the stages of team building?

Forming: Typicallycharacterized by ambiguity and confusion. Team members may be unclear about
tasks at this stage. They have not yet chosen to work together and may communicate in a superficial
and impersonal manner.
Storming: A difficult stage when there may be conflict between team members and some rebellion
against the assigned tasks. Team members may get frustrated here when do not progress well in the
tasks.
Norming: Open communication between team members is established and the team starts to
confront the task at hand. Generally accepted procedures and communication patterns are
established.
Performing: The team focuses all of its attention on achieving the goals. The team is now close and
supportive, open and trusting, resourceful and effective.
After being formed and continue to develop, healthcare teams interact dynamically and have the common
goalof delivering health services to patients.
Q. What is an effective team? What are the benefits of effective teamwork? Mention some characteristics
making effective healthcare team. What are the hurdles to effective teamwork?
Effective team: An effective team is a one where the team members, including the patients,
communicate with each other, as well as merging their observations, expertise and decision-making
responsibilities to optimize patients' care. Understanding the culture of the workplace and its impact
on team dynamics and functioning will make a team member a good team player.
Benefits of effective teamwork:
o Organizational benefits: Reduced time and costs of hospitalization, Reduction in unexpected
admissions, Services are better accessible to patients
o Team benefits: Improved coordination of care, Efficient use of health-care services, Enhanced
communication and professional diversity
o Patient benefits: Enhanced satisfaction with care, Acceptance of treatment, Improved health
outcomes and quality of care Reduced medical errors
Benefitsto team members: Enhanced job satisfaction, Greater role clarity, Enhanced welI
being
Challenges to effective teamwork: Several barriers exist to establishing and maintaining effective
teamwork in health care:
o Changing roles: In many health-care teams, there is considerable change and overlap in the
roles played by different health-care professionals. These changing roles can present
challenges to teams, in terms of acknowledgement and role allocation.
o Changing settings: Some changes in the nature of health care such as increased delivery of
care for chronic conditions require the development of new teams and the modification of
existing teams.
Health-care hierarchies: The strongly hierarchical structure of health care can be
counterproductive to well-functioning and effective teams where all members' views are
considered.
o Individualistic nature of health care:Many health-care professions, such as nursing, dentistry
and medicine, are based on the autonomous one-to-one relationship between the health
care provider and patient. While this relationship remains a core value, it is challenged by
many concepts of teamwork and shared care.
Instability ofteams: Some health-care teams are transitory in nature, coming together fora
specific task or event (e.g. Trauma teanm).
Failing teamwork leads to accidents: Reviews of high-profile incidents have identified three
main types of teamwork failings, namely, unclear definition of roles, lack of explicit
coordination and other miscommunication.
o Resolving disagreement and conflict: The ability to resolve conflict or disagreement in the
team is crucial to successful teamwork. This can be especially challenging for junior members
of the team or in teams that are highly hierarchical in nature.
Characteristics making effective healthcare team:
Common purpose
Measurable goals
Effective Leadership
Effective Communication
Good Cohesion
o Mutual respect
o Flexibility
o Performance monitoring
Conflict resolution and learning
Reliability
Willing to compromise
Commitment
o Dedication
o Adaptability
Q. State the various components of a (a) laboratory team OR (b)surgical team OR (c) research team.
Surgical Team:
Consultant/ attending Surgeon
o Surgical residents
o Anaesthesiologist
o Certified registered nurse anesthetist
o Scrub Nurse
o Operating roonm nurse or circulating nurse
o Surgical technologist
o Physician assistant
o Cleaning staff
Research Team:
o Principal Investigator (Pl)
o Sub-lnvestigator (Sub-1) /Co-Investigator (Co-!)
o Regulatory Coordinator.
Data Coordinator
Statistician
o Research Coordinator/ Research Nurse
Laboratory Team:
Laboratory Director
Head (Professor) Pathologist/ Biochemist/ Microbiologist or Technical Supervisor
Residents
General supervisor or head technician
Assistant laboratory technicians or Medical Laboratory Scientist (MLS) or Medical
Technologist (MT)
o Phlebotomist
o BSL Monitor
o Cleaning staff
a. State the need of collaborative work in health care. State the hurdles in the same.
Interdisciplinary teamwork is an important model for delivering health care to patients. Researchers
have found that integrating services among many health providers is a key component to better
treat underserved populations and communities with limited access to health care.
Collaboration in health care is defined as health care professionals assuming complementary roles
and cooperatively working together, sharing responsibility for problem-solving and making decisions
to formulate and carry out plans for patient care. Collaboration between physicians, nurses, and
other health care professionals increases team members' awareness of each other's type of
knowledge and skills, leading to continued improvement in decision making. Effective teams are
characterized by trust, respect, and collaboration. Deming is one of the greatest proponents of
teamwork.
When considering a teamwork model in health care, an interdisciplinary approach should be applied.
Unlike a multidisciplinary approach, in which each team member is responsible only for the activities
related to his or her own discipline and formulates separate goals for the patient, an interdisciplinary
approach coalesces a joint effort on behalf of the patient with a common goal from all disciplines
involved in the care plan. The pooling of specialized services leads to integrated interventions. The
plan of care takes into account the multiple assessments and treatment regimens, and it packages
these services to create an individualized care program that best addresses the needs of the patient.
The patient finds that communication is easier with the cohesive team, rather than with numerous
professionals who do not know what others are doing to manage the patient.
Across health care, there is an increasing reliance on teams from a variety of specialties (e.g.,
nursing, physician specialties, physical therapy, social work) to care for patients. At the same time,
medical error is estimated to be "the third most common cause of death in the US", and teamwork
failures (e.g., failures in communication) account for up to 70-80 percent of serious medical errors.
The shift to providing care in teams is well founded given the potential for improved performance
that comes with teamwork, but, as demonstrated by these grave statistics, teamwork does not come
without challenges. Consequently, there is a critical need for health care professionals, particularly
those in leadership roles, to consider strategies for improving team-based approaches to providing
quality patient care.
Teams offer the promise to improve clinical care because they can aggregate, modify, combine, and
apply a greater amount and variety of knowledge in order to make decisions, solve problems,
generate ideas, and execute tasks more effectively and efficiently than any individual working alone.
Given this potential, a multidisciplinary team of health care professionals could ideally work together
to determine diagnoses, develop care plans, conduct procedures, provide appropriate follow up, and
generally provide quality care for patients.
Hurdles to collaborative work: It is important to point out that fostering a team collaboration
environment may have hurdles to overcome: additional time; perceived loss of autonomy; lack of
confidence or trust in decisions of others; clashing perceptions; territorialism; and lack of awareness
of one provider of the education, knowledge, and skills held by colleagues from other disciplines and
professions. However, most of these hurdles can be overcome with an open attitude and feelings of
mutual respect and trust. A study determined that improved teamwork and communication are
described by health care workers as among the most important factors in improving clinical
effectiveness and job satisfaction.
a Describe the importance of respect in relationship with patlents, fellow team members, superiors and
other health care workers.

Respect is an essential component of a high-performance organization. It helps to create a healthy

environment in which patients feel cared for as individuals, and members of health care teams are engaged,
collaborative and committed to service. Within a culture of respect, people perform better, are more
innovative and display greater resilience. On the contrary, a lack of respect stifles teamwork and
undermines individual performance. It can also lead to poor interactions with patients. Cultivating a culture
of respect can truly transform an organization and leaders set the stage for how respect is manifested.
Respect to patients:
From a social psychological perspective, respect has been defined as "the social acceptance of
another person". The humanistic clinical psychologist Carl Rogers is well known for the concept of
unconditional positive regard. Regardless of what the patient may have thought, felt or have done,
Rogers advocated for accepting them unconditionally. Put another way, Rogers advocated for
approaching patients by respecting them as individuals who have incontestable worth as they are,
and not expecting them to behave differently to earn this respect. Also, according to another study,
patients believed that respecting persons incorporates the following major elements: empathy, care,
autonomy, provision of information, recognition of individuality, dignity and attention to needs.
Using a large sample of survey data from the Consumer Assessment of Healthcare Providers and
Systems (CG-CAHPS), the authors tested the hypothesis that the most important communication
predictor of patients' overall physician rating is the item assessing patient's perception of whether
the physician showed respect. For 23 of 28 medical specialties, showing respect was the most
predictive item of overall physician ratings, accounting for more than four times as much variance as
the other survey items assessing communication behaviors.
Respect to co-workers and superiors:
Research demonstrates that people value two distinct types of respect: 'Owed' and 'Earned.' Owed
respect meets the universal need to feel valued and included. It rests on the concept that all
individuals have inherent value and the right to be treated with dignity. When owed respect is
lacking, it manifests as over-monitoring (i.e., micromanagement), distrust, misconduct and
indifference (i.e., making people feel like they are easily replaceable). Disrespect can lead to a toxic
atmosphere that diminishes joy and fulfillment, leading to dissatisfaction and burnout. Earned
respect recognizes individuals who have gone above and beyond expectations. It meets the need to
 feel valued for accomplishments and a job well-done. Neglecting to provide earned respect can
reduce motivation and accountability.
Respect is also established by supporting other members of the health care team. Speaking poorly of
another service or health care professional undermines patients' confidence in the entire health care
team and lowers their impression of the system. Interactions with colleagues can be improved by
always assuming best intentions and giving other people the benefit of the doubt. Before reaching a
negative conclusion, ask questions to clarify and assume that best intentions were in mind.
In 2012, Virginia Mason launched a 'Respect for People' initiative that engaged all of their employees
in approaches to respecting one another in the workplace. The program involved training, simulation
and defining what respect meant. The outcome was a greater sense of personal ownership for how
employees respect, support and appreciate their coworkers. The following is their "Top 10" list of
ways to show respect:
Listen to understand
Keep your promises
o Be encouraging
Connect with others
o Express gratitude
o Share information
o Speak up
o Walk in their shoes
o Grow and develop
o Be a team player
Aculture of respect also recognizes that everyone in the organization plays a meaningful role in the
ability to care for patients. All members of the team are valued and have important contributions to
make. Respect is given to everyone, regardless of their position on the organizational chart. For
example, when a physician holds the door for a hospital cleaner, this simple act boosts self-worth
and appreciation. The same effect is seen with a thank you letter from a peer or supervisor for a job
well done.

a What isempathy? What is the role of empathy in the care of patients?

Definition; Empathy is the ability to emotionally understand what other people feel, see things from
their point of view, and imagine yourself in their place. Essentially, it is putting yourself in someone
else's position and feeling what they must be feeling. It is the action of understanding, being aware
of, being sensitive to, and vicariously experiencing the feelings, thoughts, and experience of another
of either the past or present without having the feelings, thoughts, and experience fully
communicated in an objectively explicit manner.
Signs of Empathy: Empathy is shown by various signs like being good at really listening to what
others have to say, picking up on how other people are feeling, thinking about how other people
feel, trying to help others who are suffering and so on.
Types of Empathy: Empathy can be either affective empathy, cognitive empathy or somatic empathy.
Role of Empathy:
 o Empathy involves more than just understanding a patient's medical history, signs, and symptoms.
It entails more than just a medical diagnosis and therapy. Empathy is one of the most important
instruments in the therapeutic interaction between caregivers and their patients, and its
contribution has been shown to improve health outcomes.
It strengthens the development and improvement of the therapeutic relationship between the
two parts by allowing health care providers to detect and recognise the patients' experiences,
worries, and perspectives.
It is widely accepted that a health professional's ability to empathise with patients leads to
greater treatment outcomes. The health professionals' empathetic relationship with their
patients strengthens their participation in developing a therapy plan and a tailored intervention,
boosting the patient's pleasure with the therapeutic process. As a result, the quality of care is
improved, errors are reduced, and a higher percentage of health-care recipients have a
favourable experience with therapy.
o Furthermore, it has been discovered that the sympathetic bond formed during the care process
enhances therapeutic outcomes by allowing patients to better adhere to the therapeutic plan of
action. Patients who are shown empathy during their treatment had better outcomes and a
higher chance of improving.
o Furthermore, healthcare workers with higher empathy levels perform more efficiently and
productively in terms of fulfilling their role in social transformation. This occurs because empathy
allows the healthcare worker to understand and feel sympathy for their patients, allowing them
to feel safe in expressing their concerns and issues. This creates a foundation for trust, which
leads to therapeutic change and an improvement in the overall social functionality of the care
recipient.
The ability of a person to accomplish everyday activities (preparing and keeping meals, seeking
accommodation, taking care of themselves, commuting) as well as their ability to fulfil social
roles (parent, employee, member of a community) according to the requirements of their
cultural environment are assessed by the social worker.
o Empathy aids in the accurate appraisal of the scenario in which the health-care user finds
himself. It allows therapists to make effective use of nonverbal clues (behaviour modelling, body
gestures, tone of voice, and so on) while also assisting them in managing the user's emotions.
Empathy also improves the user's ability to perceive reality and thus their quality of life.
Thus, in totality, expressing empathy is highly effective and powerful, which builds patient trust,
calms anxiety, and improves health outcomes. Research has shown empathy and compassion to
be associated with better adherence to medications, decreased malpractice cases, fewer
mistakes, and increased patient satisfaction.
a State how to break bad news to the family using SPIKES protocol.
The aim for any health-professional is to use their skills to deliver bad news clearly, honestly and sensitively
in order that patients can both understand and feel supported. It is necessary to plan as carefully as possible
and to respect the people to whom the information is being given by listening and watching them at all
stages and being responsive to their wishes and reactions, which will be diverse. The SPIKES protocol is a six
part method that sets out a straightforward process for sharing difficult-to-hear and difficult-to-deliver
news.

The SPIKES process acknowledges that the situation challenges both doctor and patient. For the doctor, it is
clearly hard to be in the position of shattering your patient's hope for their recovery. On the other hand,
nothing compares to the harsh reality that the patient themselves must face. The four main objectives laid
out by the SPIKES protocol include sharing information with the patient, gathering responses from them,
providing vital support, and creating a plan to move forward.
The steps of SPIKE are:

" Setting: The set-up of the meeting is important. You should create a warm and welcoming space that
does not seem cold or clinical. If the patient wants family or close friends to be there in support,
make sure that these people are included as well. It is not necessary to rush into the news like
dropping a bomb on an enemy; take a moment to connect and build rapport with your patient.
Whether you understand it or not, youare about to change your patient's life. Take time to show
empathy and emotional connection.
Perception: Perception refers to the patient's current level of knowledge about their medical issue
and what they think about their status on the road to recovery. It is important to do more listening
than talking at this stage; there is no need to challenge the patient on inaccurate or hopeful beliefs
at this point.
Invitation: At this stage, ask your patient if they want to know the details of their condition or the
treatment they might face. Meet your patient where they are; if they are not ready for the details, it
is not necessary to force them to listen. The SPIKES method acknowledges that each patient has
right not to know the details if they are not ready for them. Wait for permission from your patient
before proceeding with the news.
Knowledge: In this stage you are sharing knowledge and information with your patient. Again, it is
important to ask the patient how much they understand and meet them there. Your patient often
will need you to speak in plain terms, not medical jargon. Consider the individual before you; have
they understood what you said? Do not rush this part of the protocol.
Emotion: The sharing of bad news is emotional for both doctor and patient. Create space for your
patient to express their emotion and practice deep empathy. Put yourself in their shoes by
identifying their reaction - sadness, shock, denial-and helping them to identify it too.
" Strategy and Summary: End the meeting on an intentional note: what will come next? Summarize
your thoughts and your understanding of the patient's reaction, and set expectations for the next
appointment

a. Compare empathy vs equanimity.

Empathy is the ability to listen to a troubled individual and literally opening your mind up so that all the
problems, worries, negative emotions, traumas and anxiety can flow into you. You literally feel the pain as
you balance the garbage so that the other person starts to feel better when the weight gets transferred off
their shoulders and onto yours. This is basically what therapy is about, or starts out as.
Equanimity is then exactly the opposite of empathy as it's an inner state of total deflection from external
negativity, misery and nuisances. This means that whatever inner emotional state you are in is very stable,
completely of your own making and other people's misfortunes or troubles don't mean anything to you on a
mental/emotional level.
a What is sympathy? What is difference between empathy and sympathy?
Meaning: Empathy is the ability to emotionally understand what other people feel, see things from
their point of view, and imagine yourself in their place. Essentially, it is putting yourself in someone
else's position and feeling what they must be feeling. It is the action of understanding, being aware
of, being sensitive to, and vicariously experiencing the feelings, thoughts, and experience of another
of either the past or present without having the feelings, thoughts, and experience fully
communicated in an objectively explicit manner.
" Sympathy is the perception, understanding, and reaction to the distress or need of another life form.
According to David Hume, this sympathetic concern is driven by a switch in viewpoint from a
personal perspective to the perspective of another group or individual who is in need.
" Empathy is shown by various signs like being good at really listening to what others have to say,
picking up on how other people are feeling, thinking about how other people feel, trying to help
others who are suffering and so on.
" Empathy can be either affective empathy, cognitive empathy or somatic empathy. On the other
hand, sympathy is rather a broad term, signifying a general fellow feeling, no matter of what kind.
Empathy requires active listening. Sympathy requires giving unasked advice or being told what to do.
Sympathy states "I know how you feel". Empathy states "I feel how you feel". In this case, having
empathy is being more aware of the other person's feelings, not your own.
" Sympathy often involves a lot of judgement. Empathy has none.
" Sympathy involves understanding from your own perspective. Empathy involves putting yourself in
the other person's shoes and understanding WHY they may have these particular feelings. In
becoming aware of the root cause of why a person feels the way they do; we can better understand
and provide healthier options.
Sympathy tends to suppress your own and others' emotions. Emotions get pushed aside and avoided
until it culminates in an intense fit of pain. Empathy acknowledged your own and others' emotions.
" Lastly, empathy is a skilled response, while sympathy is reactive response, which is why developing
the skill of empathy is a more realistic goal for medical education, whereas teaching sympathy seems
counterintuitive.
a Write a short note on role of doctors in the community.
Roles doctors playin the community:
1. Healer
2. Educator
3. Researcher
4. Planner
5. Health Advocate
Under these roles, doctors carry out the following responsibilities:
Saving life: The COVID-19 pandemic has reminded all of us of the vital role doctors play to relieve
suffering and save lives. The pandemic has also highlighted the extent to which doctors are willing to
go in ensuring a functioning health system and a functioning society. On a daily basis doctors also
play key roles that save lives such as an emergency procedure or an elective procedure for a rather
time sensitive or serious illness. An accidental injury and troubled labor also account for the same.
Extending life: Unfortunately, not every illness can be cured completely. But with the effort of
doctors and medicines and therapies, the lifespan of the patient or onset of the worst effect of an
illness can be extended significantly. Though this time varies greatly from case to case and patient to
patient, the efforts behind the cause are commendable.
Preventive Medicine: Nobody wants to become sick, disabled or helpless. Preventing sickness or
injury is a better choice: It's less expensive, better for our health and we lose less income if we don't
get sick too often. Preventive treatment is also important for society as a whole. Many people in the
U.S. and around the world can't afford drugs, hospital stays or surgery. By promoting preventive
medicine and keeping people healthy, doctors reduce the health gap between rich and poor
populations.
Stopping Pandemics: Although doctors have not been able to completely stop the current
Coronavirus pandemic, they have significantly reduced mortality from the disease. Black death and
smallpox have wiped out millions of people throughout history; polio paralyzed thousands in the 2oth
century. By working to contain potential epidemics, doctors prevent disasters. Individual doctors
don't fly solo in these crises. Fighting plagues takes money and organizations that work on a national
and international scale. But doctors and other medical professionals are vitally important in the fight.
Improving lives: Not every disease threatens the life of the patient. However, living with the
discomforts for a lifetime is not an acceptable option either. The effort of doctors makes it possible
to mitigate these discomforts and help live their life to the fullest.
Economic Impact: Amedical practice is a small business. Most doctors employ staff and rent or buy
office space, pay contractors for repairs and generally improve the community's economic health as
they improve their patients' health. For instance in 2018, Illinois had 30,000 doctors who support
146,000 jobs and indirectly support 250,000 more. A hospital or medical practice can be an
economic driver in towns too small to support most other industries.
Nutritional Emergencies:Doctors play a major role in nutritional emergencies, hunger and
malnutrition are rampant among refugees and displaced populations, representing currently around
40 million people worldwide, many of whom - infants, children, adolescents, adults and older people
-suffer from one or more of the multiple forms of malnutrition.
Educating People:In the internet age, there's no shortage of medical malarkey flying around online.
Whatever you're suffering from, someone knows a miracle cure. Whatever you're scared of, some
website will shriek that it is much, much worse than you think. Doctors have the standing and the
knowledge to push back against fake medical news. It's not just about teaching patients the real
 steps to staying healthy. Sometimes it's explaining that there is no cure and so no point to spending
money trying to conjure one up.
Shaping Health Policy: State, local and federal governments have a big influence on our
communities' health. Is our water safe to drink? Our food safe to eat? Is there a local treatment
program for alcoholics or people hooked on painkillers? If contagious disease is a threat, how does
the government mobilize doctors and other professionals? Doctors are only one voice among many
that shape public policy. But they have a unique position of respect and trust, which they can use to
push governments toward healthcare policies that will genuinely benefit the public.
Military Roles: A military doctor provides health care to military personnel and their families and can
work in a variety of settings, including hospital ships and international medical centers. Doctors
enlisted in the military might take part in international relief efforts by providing care to victims of
natural disasters. The military primarily employs doctors with specializations in common types of
medicine such as pediatrics, family care, and neurology. If you would like to become a military
doctor, you must earn a medical degree and meet military requirements.
a Write a short note on expectations of society from doctors.
The society has various expectations from doctors and the healthcare care. These can be summarised as
follows:
The services of the healer: Society's primary expectation is that individuals will receive the services of
the healer. They want caring and compassionate treatment, with their confidentiality respected and
their dignity preserved. Furthermore, they want to retain control of the direction of their own
treatment. Medicine must fulfill this role.
Guaranteed competence: Society expects that the profession will ensure the competence of each
physician by setting and maintaining standards for education, training, and practice-and by
disciplining incompetent, unethical, or unprofessional conduct. The obligation of individual
professionals is to maintain their own competence and to participate in the process of self
regulation.
Altruistic service:Physicians are empowered to ask intrusive questions and carry out invasive
procedures. For this to be permitted, patients must trust that their physicians will not pursue self
interest but have the patient as their first priority. This must not be an open-ended commitment that
is incompatible with a healthy physician's lifestyle, but altruism is central to the social contract. The
pervasive nature of conflicts of interest must be recognized and managed by individual physicians if
they are to maintain patient trust. Professional organizations are also expected to demonstrate
altruism, putting the interests of society above their own.
Morality and integrity: Physicians are expected to demonstrate morality and integrity in their
practice, and in their day-to-day lives. Physicians who do not do s0 will, without question, lose trust,
and this will reflect upon the profession as a whole.
Promotion of the public good:Inasmuch as the profession is given a monopoly over the practice of
medicine, it is expected that its members will address the problems faced by individual patients and
also concern itself with issues of importance to society.
Transparency: Historically, professions carried out their deliberations in a relatively closed manner.
This is no longer acceptable; it is now expected that public membership in regulatory bodies will be
significant and that the establishment and maintenance of standards and policy will be done in
consultation with public representatives.
Accountability: For generations, physicians recognized that they were accountable to individual
patients, to the public for advice on policy, and to each other for self-regulation. As medicine
became more costly, it was inevitable that physicians would become accountable in both economic
and political terms. These newer levels of accountability are a cause of major tension. Aphysician's
fiduciary duty to patients now comes into conflict with the social purposes of medicine. Devoting
resources to the care of a single patient inevitably diminishes the resources available for other
patients. As the contract evolves, this tension will remain, but medicine's fiduciary duty to individual
patients must take priority.