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Using shift-work performance impairment similar to that induced by a models familiar in the world of emergency medicine but less blood alcohol level of 0 purchase cheap silvitra online erectile dysfunction drugs at cvs. Increasingly cheap silvitra line erectile dysfunction weight loss, programs are developing poli- human resource issues that generic silvitra 120mg free shipping erectile dysfunction diabetes viagra, she readily admits buy 100mg kamagra polo visa, are more cies to minimize the use of pagers discount eriacta. The pro- gram director also begins to shift educational sessions to Invest in other human resources. By optimizing the involve- models that allow for ready digitization and remote access ment of physician assistants, nurse practitioners, phlebotomists, by residents. These professionals can help ensure medical errors, adverse events, and attentional failures. Extended work shifts and the risk of motor indeed, all hospital professionals) are particularly vulnerable vehicle crashes among interns. Many other practical and comprehensive solutions to the bur- den of excessive work hours during residency, as described by Ulmer and colleagues can be considered in a Canadian context. As we continue to improve patient safety, quality outcomes and excellence in residency training and education, we will need to be open to more systemic interventions targeting fatigue management. First and foremost, they expect that their physicians may confict with those of their training pro- physician will be competent. They ex- Case pect to be trusted because it is diffcult to carry out the healing A fnal-year surgical resident has been the lead doctor function in the absence of trust. They wish to be given suf- treating a 62-year-old widow with carcinoma of the colon. They The resident carried out the surgical procedure with the expect patients to accept some responsibility for their own assistance of the attending surgeon. Canadian physicians want their health care system to be the resident and regards the resident as her surgeon. The equitable, adequately funded and staffed, and to afford reason- patient is aware of the diagnosis and understands that able professional freedom. She lives alone there is a balance between the practice of medicine, family and and wants her family to participate in the discussion about other interests. Finally, they expect reasonable rewards, both treatment options before her discharge. In Canada, the broad outline of these has tickets to a hockey game with their son as a birthday expectations is documented in a contract. For Introduction example, it is inconceivable that a resident would leave a care Professionalism has been described as the basis of medicine s setting at the end of a shift when to do so would put a patient s social contract with society. The most signifcant tension that This bargain with society leads to tangible expectations on may arise stems from a confict between altruism a sense of the part of patients and society on one side and on the part of obligation to put patients needs above one s own and the physicians and the profession on the other. In contem- all of the obligations expected of physicians in a complex and porary Canada, this tension is exacerbated by a real shortage of frequently underfunded and understaffed health care system physicians and other health care professionals, which has led often places impossible demands on individual physicians.

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