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July 22, 1974

Defensive Medicine

JAMA. 1974;229(4):394. doi:10.1001/jama.1974.03230420015015

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To the Editor.—  Mr. Bergen unequivocally stated in his article that there is no substantial addition to the health care cost of our nation because of "defensive medicine," and I think this statement is not true.The two surveys quoted by Mr. Bergen, noting that about 60% of physicians had modified their practice because of the threat of malpractice suits, would seem to substantiate my position rather than that of the author. There is little doubt in my mind that as I watch the practice of medicine, the number of hospital admissions, laboratory studies, x-ray examinations, and consultations have increased as the frequency of successful malpractice litigation has increased.A question was raised: "How does one determine that a particular test is unnecessary?" It was followed by several obvious examples of valuable negative reports suggesting that random testing of the entire population would be acceptable if even a very small