Technology Assessment and the Fear of Litigation-Reply

In Reply.—  Dr Wizenberg expresses a concern that is widely held by our peers in clinical medicine about the impact of medical malpractice on clinical judgment. Indeed, malpractice litigation has been characterized as "the single most talked-about topic among physicians"¹ and "the most potent environmental factor currently affecting obstetricians and gynecologists."² As a result, physicians and others have argued that the legal system is fraught with too many lawsuits and too many large jury awards for plaintiffs. In an 11-state study reported on in 1989, however, it was found that few cases in obstetrics and gynecology actually go to a jury trial, and, in fact, plaintiffs usually do not win.³ A small portion of obstetric and gynecologic cases result in a jury trial, and physicians win most of the time. When physicians lose, it is likely to be in situations that involve severe injuries and older, well-established