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Why health care needs resilient practitioners.

INTRODUCTION Frank (2004) argues that when we enter into a relationshipwith apatient in aoneto-one interaction we can give to that therapeutic moment all our attention, knowledge compassion and care. The moment a third party enters the roomwe are required to invoke justice to ensure that all three are party to the same rights, privileges and observe similar obligations. To satisfy this end, systems are introduced to ensure fairness and equity. In health care, providers must demonstrate their accountability to the taxpayer and provide assurance that services are delivered according to prescribed standards. This requires there to be greater precision in collecting and collating data (paperwork) to evidence theseoutcomes. The systems, tools and methods by which fairness, equityandaccountability are evidenced have reached exponential proportions and are increasingly burdensome to practitioners attempting to deliver care at the bedside (Bowen and Kriendler, 2008). Frequently, new systems that quantify and risk manage care can reconstruct practice into a set of competing and contradictory demands that rarely captures the caringmomentof a one to one therapeutic interaction with a patient. The system then becomes something that distances the practitioner from the patient, or can be used to shield the practitioner from taking responsibility for the care that is provided because they act according to the determinants of the system not necessarily their own professional or personal values (Coombs, 2008). In this editorial I wish to explore the following issues: