▁become ▁known ▁as ▁def ensive ▁medicine , ▁" a ▁deviation ▁from ▁sound ▁medical ▁practice ▁that ▁is ▁indicated ▁primarily ▁by ▁a ▁threat ▁of ▁li ability ". ▁ ▁Form s ▁ ▁Def ensive ▁medicine ▁takes ▁two ▁main ▁forms : ▁ass urance ▁behavior ▁and ▁avoid ance ▁behavior . ▁Ass urance ▁behavior ▁involves ▁the ▁charg ing ▁of ▁additional , ▁unnecessary ▁services ▁to ▁a ) ▁reduce ▁ad verse ▁out comes , ▁b ) ▁d eter ▁patients ▁from ▁fil ing ▁medical ▁mal p ract ice ▁claims , ▁or ▁c ) ▁pre empt ▁any ▁future ▁legal ▁action ▁by ▁document ing ▁that ▁the ▁pract ition er ▁is ▁pract icing ▁according ▁to ▁the ▁standard ▁of ▁care . ▁A void ance ▁behavior ▁occurs ▁when ▁prov iders ▁refuse ▁to ▁particip ate ▁in ▁high ▁risk ▁procedures ▁or ▁circumstances . ▁ ▁Ex amples ▁ ▁In ▁ 2 0 0 4 , ▁the ▁case ▁of ▁Dr . ▁Daniel ▁M eren stein ▁triggered ▁an ▁int ensive ▁debate ▁in ▁scientific ▁journ als ▁and ▁media ▁on ▁def ensive ▁medicine ▁( e . g ., ) ▁Following ▁the ▁gu idel ines ▁of ▁several ▁well - res pected ▁national ▁organizations , ▁M eren stein ▁had ▁explained ▁the ▁pros ▁and ▁cons ▁of ▁pro state - specific ▁ant igen ▁( PS A ) ▁testing ▁to ▁a ▁patient , ▁rather ▁than ▁simply ▁ordering ▁the ▁test . ▁He ▁then ▁documented ▁the ▁shared ▁decision ▁not ▁to ▁order ▁the ▁test . ▁Later , ▁the ▁patient ▁was ▁diagn osed ▁with ▁in cur able ▁advanced ▁pro state ▁cancer , ▁and ▁M eren stein ▁and ▁his ▁res iden cy ▁were ▁su