Informed consent in medicine: one physician's perspective.

The American physician is today besieged by economic and societal forces which conspire to weaken whatever equanimity he or she could once bring to the practice of medicine. In the latter realm, the threat of malpractice actions is ever-present. In this regard, negligence has long been the theory whereupon plaintiffs' attorneys seek to recover damages for patients' misfortunes in the medical system. However, when no physician negligence can be shown to be the cause of bad medical outcomes, lack of informed consent has become an alternative theory for attorneys to use in pursuing legal action. This development in the law balances a laudable effort to protect patients' autonomy rights against an often intolerable burden for physicians. What to tell patients is thus a matter of paramount concern in the era of risk management. The issue of informed consent is a relatively recent development in the history of medicine. Traditionally the doctor-patient relationship has been paternalistic. In ancient Greece, Hippocrates advised physicians to