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Academic Medicine:
doi: 10.1097/ACM.0b013e318294fd5b
Perspectives

A Humble Task: Restoring Virtue in an Age of Conflicted Interests

DuBois, James M. PhD, DSc; Kraus, Elena M.; Mikulec, Anthony A. MD, MBA; Cruz-Flores, Salvador MD, MPH; Bakanas, Erin MD, MA

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Abstract

Virtues define how we behave when no one else is watching; accordingly, they serve as a bedrock for professional self-regulation, particularly at the level of the individual physician. From the time of William Osler through the end of the 20th century, physician virtue was viewed as an important safeguard for patients and research participants. However, the Institute of Medicine, Association of American Medical Colleges, and other policy groups—relying on social science data indicating that ethical decisions often result from unconscious and biased processes, particularly in the face of financial conflicts of interest—have increasingly rejected physician virtue as an important safeguard for patients.

The authors argue that virtue is still needed in medicine—at least as a supplement to regulatory solutions (such as mandatory disclosures). For example, although rarely treated as a reportable conflict of interest, standard fee-for-service medicine can present motives to prioritize self-interest or institutional interests over patient interests. Because conflicts of interest broadly construed are ubiquitous, physician self-regulation (or professional virtue) is still needed. Therefore, the authors explore three strategies that physicians can adopt to minimize the influence of self-serving biases when making medical business ethics decisions. They further argue that humility must serve as a crowning virtue—not a meek humility but, rather, a courageous willingness to recognize one’s own limitations and one’s need to use “compensating strategies,” such as time-outs and consultation with more objective others, when making decisions in the face of conflicting interests.

© 2013 by the Association of American Medical Colleges

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