Not long ago, I heard a respected senior colleague recount to a group of medical students and trainees the story of a patient who had died under his care some 15 years earlier. Afterward, he had spent hours talking with the family, trying, he said, “to be as kind to them as I possibly could.” The family had been grateful for all his efforts, but my colleague still struggled even to tell the story.

“Were you afraid of getting sued?” one of the students suddenly asked.

My colleague’s eyes widened, and he answered slowly, the tone of his voice shifting from grieving to professorial. “In medicine, malpractice isn’t something we just think about when a patient dies. Malpractice is always in the back of your mind.”

The handful of senior doctors in the room nodded in grim agreement. Every one of us either had been named in or knew of a colleague embroiled in litigation. That evening we all urged the aspiring clinicians to be the best and most compassionate doctors they could be. We knew all too well how much easier it is simply to order more tests and procedures than necessary and to overtreat in hopes of avoiding a lawsuit.

But a study published earlier this year in the American Journal of Obstetrics and Gynecology has revealed that a group of doctors at Yale-New Haven Hospital has been quietly working to change the culture of “defensive medicine” that so many have come to accept as inevitable.

Beginning in 2003, the hospital’s department of obstetrics and gynecology, in collaboration with their malpractice insurance carrier, initiated a series of reforms to improve care. Those in charge had no illusions. Obstetrics was, and remains, one of the most legally embattled specialties, accounting for the highest proportion of malpractice payouts over $1 million. Their goal was only to make a small dent in adverse patient outcomes.