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We thank Dr Liu for responding to our article. It was beyond the scope of our article to provide a history of medical ethics. Suffice it to say that ethics has been part of the history of medicine from the earliest times in cultures around the world.1Jonsen A.R. A short history of medical ethics. Oxford University Press, New York2000Google Scholar We drew on Hobbes, Hoffmann, and Gregory because of their pertinence to the ethical challenges of physician leaders today. The history of medical ethics is not only of scholarly interest; it also provides powerful concepts that physician leaders can use to responsibly shape organizational culture. Dr Liu asks a very timely question: which type of physician leader could survive in an academic medical center now? This is a judgment, we believe, best left to each reader—and the answer will provide an ethical diagnosis of the state of his or her center’s organizational culture. Whether the reader should be pleased (Gregorian culture), concerned (Hoffmannian culture), or dismayed (Hobbesian culture) is likewise a judgment that we entrust to the reader. Finally, Dr Liu invokes the Five-Step Model for transformational change. This is a useful tool for physician leaders to use, but only if they can make a reliable account to their colleagues of the changes that should be made in their academic medical center. Ethics is essential for making such an account. It is more important to know what changes physician leaders should be pursuing—at least Hoffmannian and better Gregorian, in our judgment—than to know processes for change. Put another way, the questions of “who decides” is very important, but “what should be decided” is in all cases the more fundamental question confronting physician leaders. Physician leader should create knowledge-sharing organizational cultureAmerican Journal of Obstetrics & GynecologyVol. 196Issue 4PreviewI wish to comment on the article by Chervenak et al.1 dealing with ethics and power relationship of physician leaders in obstetrics and gynecology. The authors drew on three famous historic figures to elucidate the dimensions of authority and power, as well as of leadership systems within institutions, a project surely of interest to scientific readers. However, the authors did not address the following: 1) are ethics actually neglected in this professional society or its associated hierarchical system?; 2) what are the requirements and elements of professional ethics befitting such a professional society?; 3) how did they construct the system of ethics? Organizational culture could be one influencing factor, but a series of stepwise processes, such as organization policy, mission, vision, and value, and strategic planning, as well as leadership type and management way of doing things, could be the real factors that get things done. Full-Text PDF