▁families . ▁In ▁Switzerland , ▁for ▁instance , ▁the ▁rate ▁of ▁h yst ere ct omy ▁in ▁the ▁general ▁population ▁is ▁ 1 6 %, ▁whereas ▁among ▁female ▁do ctors ▁and ▁female ▁partners ▁of ▁do ctors ▁it ▁is ▁only ▁ 1 0 %. ▁ ▁Con sequ ences ▁ ▁Fin an cial ▁ ▁Def ensive ▁medical ▁decision ▁making ▁has ▁spread ▁to ▁many ▁areas ▁of ▁clin ical ▁medicine ▁and ▁is ▁seen ▁as ▁a ▁major ▁factor ▁in ▁the ▁increase ▁in ▁health ▁care ▁costs , ▁estimated ▁at ▁tens ▁of ▁bill ions ▁of ▁dollars ▁ann ually ▁in ▁the ▁USA . ▁An ▁analysis ▁of ▁a ▁random ▁sample ▁of ▁ 1 4 5 2 ▁closed ▁mal p ract ice ▁claims ▁from ▁five ▁U . S . ▁li ability ▁ins ur ers ▁showed ▁that ▁the ▁average ▁time ▁between ▁injury ▁and ▁resolution ▁was ▁ 5 ▁years . ▁ ▁Ind em n ity ▁costs ▁were ▁$ 3 7 6 ▁million , ▁and ▁defense ▁administration ▁cost ▁$ 7 3 ▁million , ▁resulting ▁in ▁total ▁costs ▁of ▁$ 4 4 9 ▁million . ▁The ▁system ’ s ▁overhead ▁costs ▁were ▁ex or bit ant : ▁ 3 5 % ▁of ▁the ▁in dem n ity ▁pay ments ▁went ▁to ▁the ▁pla int iffs ' ▁att or ne ys , ▁and ▁together ▁with ▁defense ▁costs , ▁the ▁total ▁costs ▁of ▁lit ig ation ▁amount ed ▁to ▁ 5 4 % ▁of ▁the ▁compens ation ▁paid ▁to ▁pla int iffs . ▁ ▁Pat ient ▁care ▁ ▁The oret ical ▁arguments ▁based ▁on ▁util itar ian ism ▁conclude