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Trends in American medicine: problems for the defense expert.

American medicine is undergoing an unprecedented upheaval in its relationship with government, third party payers, business and professional groups, with its patients, and most of all within itself. These trends take the form of movements away from specialization which had been increasing until just recently; the introduction of practice criteria and practice guidelines; the virtual elimination of fee for service medicine; the creation of multiple physician health care organizations working in managed competition; and the grouping of doctors into provider organizations offering credit lines to health care systems. These trends, along with decreasing reliance on tissue diagnosis, declining support of medical research and ever-expanding health care teams have definite impact on the issue of negligence. The foregoing is an attempt to define these and to make some educated guesses as to their impact on health care delivery in the United States in the next several years and the ways in which the negligence climate is likely to change.