Defensive behavior of Dutch family physicians. Widening the concept

Defensive medicine is commonly defined as "deviations, induced by a threat of liability, from what the physician believes is, and what is generally regarded as sound medical practice." Although, generally speaking, there is much concern about its prevalence and its consequences for American health care, some authors argue that much of what is passed off as defensive medicine has little to do with fear of lawsuits, because defensive medicine also occurs in countries where malpractice litigation is rare. Studies done in The Netherlands, where there is very little malpractice litigation, indicate that a desire to prevent problems in the doctor-patient relationship is a major cause of defensive behavior by family physicians. We suggest that a wider conceptualization of defensive medicine may improve our understanding of the American situation.