Doctoring as leadership: the power to heal
Abstract
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.
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It is illness itself, and not medical paternalism, that makes patients vulnerable.
“For one thing, it is illness itself, and not medical paternalism, that makes patients vulnerable.99”
In health care, the oversimplification and downplaying of local situations can have highly negative effects, as medicine is inherently exception-filled and medicine's internal goods are not, in large part, reducible to formulaic rules and nostrums.
“In an area such as health care, this can have highly negative effects, as medicine is inherently exception-filled (most cases differ in some way from the 'textbook case') and medicine's internal goods are not, in large part, reducible to formulaic rules and nostrums.98,99”
Professional norms assume that there are aspects of the unequal relation between doctors and patients whose legitimacy is socially conferred, due largely to illness making people vulnerable and in need of society's help.
“While these professional norms are shifting to incorporate, to varying degrees, the ideal of the active and empowered patient, they also assume that there are aspects of the unequal relation between doctors and patients whose legitimacy is socially conferred, due largely to the fact that illness makes people (in a range of ways) vulnerable and in need of society's help.99”
The cognitive institution of society's expectations about health professionals facilitates doctor-patient interaction and produces a legitimate hierarchy of domination and subordination recognized by all participants.
“This 'cognitive institution' facilitates doctor-patient interaction and produces a 'legitimate hierarchy of domination and subordination, recognized by all participants' (p.397) 99”
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- Authors
- Schei, E.
- Affiliations
- University of Bergen (NO)
- Corresponding author
- Schei, Edvin
- ORCID
- Schei, Edvin
- Venue
- Perspectives in biology and medicine
- Publisher
- Project MUSE
- Published
- 2006-06
- Volume
- 49
- Issue
- 3
- Pages
- 393-406
- ISSN
- 0031-5982 (ISSN-L)
- 1529-8795
- OpenAlex
- W2064256669
- Cited by
- 70
- References
- 44
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 3 · 2023: 2 · 2022: 3 · 2021: 4 · 2020: 2 · 2019: 3 · 2018: 1 · 2017: 4 · 2016: 7 · 2015: 5 · 2014: 12 · 2013: 9 · 2012: 7
- FWCI
- 0.33
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Perspectives in biology and medicine (publishedVersion)
- PubMed (publishedVersion)
- Project Muse (Johns Hopkins University) (submittedVersion)
- DigitalGeorgetown (Georgetown University Library) (submittedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
- Health Sciences › Medicine › Psychiatry and Mental health › Medicine, History, and Philosophy
- Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
- Keywords
- clinical leadership, physician power, structural power, symbolic power, healing, patient trust, patient vulnerability, medical ethics, medical education, character development, empathy, physician-patient relationship, patient encounters
- MeSH terms
- Empathy, Humans, Leadership, Philosophy, Medical, Physician-Patient Relations, Physician's Role, Power, Psychological, Symbolism, Paternalism, Patient Rights, Trust
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