title: Dyshormonia Iatrogenica: crossroads of medicine, malpractice law, and professional ethics in clinical endocrinology.
abstract: OBJECTIVE
  To present 2 challenging cases of patients who request endocrine therapies that their physician considers to be outside of the standard of care.
  
  
  METHODS
  With these complex cases as a backdrop, we explore the constructs of medicine, malpractice law, and professional ethics that guide physicians' medical decision-making processes.
  
  
  RESULTS
  These cases illustrate a common conundrum for clinical endocrinologists, who often find themselves struggling to balance patient satisfaction and well-being with generally accepted standards of medical care. From the perspective of a malpractice lawyer, we review the keys to limiting medicolegal liability, with emphasis on thorough documentation, informed consent, and effective doctor-patient communication. We then review the constructs of professional ethics that guide patient care, with emphasis on virtues of the "good physician," patients' right to self-determination, and paternalism. Finally, we explore some justifications for a compassionate physician to refuse a patient's desired treatment plan.
  
  
  CONCLUSIONS
  In the end, we hope that this manuscript helps to facilitate best medical, legal, professional, and ethical practices of clinical endocrinology.
authors.affiliation: Department of Internal Medicine, Section of Endocrinology, Yale University School of Medicine, New Haven, Connecticut, USA. p.goldberg@ymail.com
authors.forename: Philip A
authors.initials: PA
authors.lastname: Goldberg
authors.forename: David J
authors.initials: DJ
authors.lastname: Varriale
authors.forename: Mark R
authors.initials: MR
authors.lastname: Mercurio
mesh_terms: D000328:Adult; D004704:Endocrinology / Q000941:ethics* / Q000379:methods*; D004995:Ethics, Professional; D005260:Female; D006801:Humans; D008318:Malpractice / Q000331:legislation & jurisprudence*; D008875:Middle Aged