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Commentary
November 8, 1999

Billions for DefenseThe Pervasive Nature of Defensive Medicine

Arch Intern Med. 1999;159(20):2399-2402. doi:10.1001/archinte.159.20.2399

DEFENSIVE medicine is widely condemned but is inextricably interwoven into daily medical practice. This produces significantly higher medical costs and unrecognized distortions in the provision of medical care. Malpractice litigation is the primary cause of defensive medicine. Physicians can no longer define standards of care without reference to societal standards. Defensive medicine must be acknowledged before it can be appropriately evaluated.

Physicians practice defensive medicine all the time. Some of us know it, acknowledge it, and accept it. Others believe this to be quite untrue and find the concept "morally unconscionable"1 and "reprehensible."2 Precisely because the concept is elusive and the practice is pervasive, it is incumbent upon us to define the process and understand its effects. Not until then will we be able to do something about it.

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