The article by Dr. Waxman in the January 2015 issue of ACEP Now [“What Is Really Driving Defensive Medicine?”] describes a study that found no real difference in clinical behavior after changing the malpractice threshold in three states. He suggests malpractice worries do not drive extra testing. I wonder if the time frame of the studies is sufficient. We are all aware of the concern that changes in clinical guidelines take several years to permeate the profession. I suspect the physicians in these states are just as slow to change longstanding behaviors, particularly when the legislature can always change the rules again.
—William E. Gotthold, MD Wenatchee, Washington