Doctoring as leadership: the power to heal.

摘要

Physician power has been attacked, and tabooed, in legitimate efforts to strengthen patients' rights. Yet the structural and symbolic power wielded by doctors is what makes good and right healing actions possible. Avoiding the power issue contributes to a confusing state, where patient trust is faltering and physicians are uncertain about how to fulfill the doctor's role with the intellectual tools of mere science and technology. I argue that constitutive characteristics of health, illness, and the clinical encounter necessitate a prescriptive and responsible healing agent who is more than a technocrat, an information broker, or a seller. The article proposes clinical leadership as a concept offering practical and ethical direction to clinicians, education, research, and health policy. Leadership presupposes reflective awareness of physicians' structural and symbolic power, and is displayed as discerning, empowering improvisations in critical situations, based on empathy and willingness to learn from patients. The notion of clinical leadership highlights patient vulnerability, medicine's ethical core, and the importance of character development in medical education.