The moral foundation of medical leadership: The professional virtues of the physician as fiduciary of the patient

Leadership in medicine, as in other settings, should be based on values tha t provide appropriate direction for the use of institutional power and auth ority. 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 conc ept from the history of eighteenth century medical ethics and develop it in terms of four professional virtues-self-effacement, self-sacrifice, compas sion, and integrity. We apply these four virtues to show how physician-lead ers should create a moral culture of professionalism in health care organiz ations. We then identify four vices-unwarranted bias, primacy of self-inter est, 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 b ecome vital elements in physicians being able to maintain their professiona lism. Physician-leaders bear major responsibility to shape organizational c ultures that support the fiduciary professionalism of physicians.