The moral foundation of medical leadership: The professional virtues of the physician as fiduciary of the patient
The moral foundation of medical leadership: The professional virtues of the physician as fiduciary of the patient
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DOI：
10.1067/mob.2001.113854
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发表时间：
2001-04-01
影响因子：
9.8
通讯作者：
McCullough, LB
中科院分区：
文献类型：
--
作者：
Chervenak, FA;McCullough, LB
在医学领域的领导，就像在其他环境中一样，应该建立在为机构权力和权威的使用提供适当指导的价值观基础上。领导能力还需要管理能力。管理知识和技能可以用于有价值和无价值的目标，因此需要道德基础。运用伦理学的方法，我们认为，医生作为病人的道德受托人的概念应该是医生领导者管理决策的道德基础。我们从18世纪医学伦理学的历史中汲取这一概念，并将其发展为四种职业道德-谦逊、自我牺牲、同情和正直。我们应用这四个美德来展示医生领导者应该如何在医疗机构中创造一种职业道德文化。然后，我们确定了四个恶习--毫无根据的偏见，自我利益至上，铁石心肠和腐败--破坏了这种职业道德文化。由于卫生保健组织现在在病人护理中发挥着核心作用，因此他们的道德文化和医生领导者已经成为医生能够保持专业精神的重要因素。医生领导者承担着塑造组织文化的主要责任，以支持医生的受托专业精神。
Leadership in medicine, as in other settings, should be based on values that provide appropriate direction for the use of institutional power and authority. Leadership also requires managerial competence. Managerial knowledge and skills can be used for worthy and unworthy goals and therefore require a moral foundation. Using the methods of ethics, we argue that the concept of the physician as the moral fiduciary of the patient should be the moral foundation of management decisions by physician-leaders. We take this concept from the history of eighteenth century medical ethics and develop it in terms of four professional virtues-self-effacement, self-sacrifice, compassion, and integrity. We apply these four virtues to show how physician-leaders should create a moral culture of professionalism in health care organizations. We then identify four vices-unwarranted bias, primacy of self-interest, hard-heartedness, and corruption-that undermine this moral culture of professionalism. Because health care organizations now play a central role in patient care, their moral culture and therefore physician-leaders have become vital elements in physicians being able to maintain their professionalism. Physician-leaders bear major responsibility to shape organizational cultures that support the fiduciary professionalism of physicians.