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In the mid-1970s rates for medical malpractice insurance skyrocketed. Since that time the specter of medical malpractice litigation has preoccupied physicians. In some areas of practice, such as anesthesia, this fear of litigation and the costs of malpractice insurance have led to reforms that have both improved patient safety and reduced malpractice insurance costs. In other areas, destructive patterns of defensive medicine have evolved. These have increased medical care costs and complicated patient care and have not reduced malpractice claims and the resulting insurance premiums. These inconsistent responses to a common problem result from the paucity of useful empirical data about medical malpractice litigation.

The material in this chapter reflects both the general literature and empirical research conducted by one of the authors, but it is not a review of the literature. The intent of the chapter is to help physicians separate the medical practice problems from problems that stem from the structure of the malpractice insurance business. The goal is to help physicians practice constructive preventive law rather than destructive defensive medicine.

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