Virtue, foible, and practice--medicine's arduous moral triad.

Moral distress is often discussed as a response to the moral dilemmas that professional and other caregivers encounter in their effort to balance competing moral principles, or to provide care in difficult cases, to difficult patients, in spite of difficult institutional requirements or policy. In this essay, a reforming ER clinician and teaching physician, offers a personal approach to moral distress. Assuming that a clinician's own foibles may sometimes contribute to another's distress, and that attempting to rationalize or subvert these foibles causes moral fatigue, he offers personal guidelines for healthcare providers--four strategies that less-than-perfect practitioners may use while striving to attain the ideal of the competent, compassionate, altruistic, calm, and wise clinician.