Enlightened Versus Normative Management: Ethics versus Morals

Abstract

We generally think of management as an independent, self-contained subject. Everybody in the working process is managing something. Responsibility for medical acting gets increasingly shifted from the patient-physician relationship so that management increasingly ``performs medicine.{''} The decisions have been made in advance, yet the responsibility for the negative result falls on the individual physician. Every time a doctor or healthcare worker is at fault, management and administration are also. The standard practice of requiring excessive overwork is bad ethics, bad medicine, bad science, and bad management. Medical professionals are among the most highly stressed occupational groups. Most stress is due to management and organizational factors. The blame for burnout is falsely ascribed to the individual burnt out physician or nurse, not to the system. Thus individualization of responsibility covers again the responsibility of perverse management.