Side-by-side with the quintessential scientific process and humanistic values, doctors' behavior and decisions in the clinical encounter are increasingly influenced by 'foreign' considerations that are little mentioned and seldom recognized as a significant force. Many such issues can be identified in the literature. They include reactions to uncertainty and to fear of litigation or complaint; responses to pressures of managed care organizations; time constraints; avoidance of exposure to emotions and suffering; yielding to demands of patients or families; compromises made due to the presence of the computer as a third party in the encounter; and the accumulating effects of work-related stress. All these varied factors, many of them new in the arena or increasing in importance in recent years, often cause angst in the clinician. Thus, they may skew the doctor's behavior and decisions away from 'best' evidence-based and compassionate medical practice towards less optimal, but angst-reducing solutions. Several multifaceted approaches may prove useful in minimizing angst-driven medicine and its potential harm, thus improving the quality of care.