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September 4, 1987

Defensive Medicine

Author Affiliations

Wright State University School of Medicine Dayton, Ohio

Wright State University School of Medicine Dayton, Ohio

JAMA. 1987;258(9):1176. doi:10.1001/jama.1987.03400090060031

To the Editor.—  In his editorial entitled "Defensive Medicine: It Costs, but Does it Work?,"1 Dr Harris hits the nail squarely on the head. Much of what generally passes for defensive medicine, as measured by self-reports of physician behavior, is based more on popular mythology than acceptable medical or legal standards and consequently conveys little or no clinical benefit or legal protection.This counterproductive phenomenon is especially well illustrated in the case of excessive overuse of diagnostic testing procedures. As a colleague and I have attempted to demonstrate using tonometry testing for glaucoma as a model,2 diagnostic testing that is not based on solid scientific evidence and sound biostatistical probabilities is likely to be economically wasteful, nonbeneficial or even harmful clinically, and neutral at best for the physician's legal position.The current medical malpractice situation in the United States is indeed a crisis, demanding major alterations both in the