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As a member of the healthcare community, I read with concern the recent discussion regarding insurers and doctors.  In my field, dealing with conditions of the breast, especially abnormalities detected on screening, is especially challenging in the current climate. Any lesion detected through screening carries a risk of malignancy.  I have diagnosed patients to have breast cancer with reported normal, benign or probably benign findings on their imaging studies. Doctors are legally bound to offer options for managing these findings and are obliged to present the risks, although low, of missing a cancer if biopsy is not performed and the lesions are monitored. There are patients who elect to undergo a biopsy with its attendant procedural risk rather than wait a few months to see if the lesion progresses. When asked to cover the cost for a biopsy for benign or probably benign lesions, many insurers often refuse to do so. Not only do the insurers challenge the doctor’s agreement to biopsy the lesion according to the patient’s decision, but they also threaten doctors with non-compliance and removal from insurance panels. However, if a biopsy is not done and there is delayed diagnosis, it is not the insurers who are held accountable or suffer the consequences. The patient is the one who bears the burden of a late diagnosis and poorer chances of cure, while it is the doctor who will have to bear the medico-legal responsibility of a delayed diagnosis, even though he may have been pressured by the insurance company not to perform a biopsy.  Insurers who hinder patient autonomy bear no legal responsibility. For the sake of remaining on the insurance panel, the doctor becomes vulnerable to disciplinary or legal action. We have also seen that the penalties for doctors who are found to have delayed intervention, like specialist referral, specialised investigations or a biopsy, can be extremely harsh. This has led to a low threshold for referral and investigations which naturally leads to increased cost. I would argue that this is a symptom of defensive medicine rather than a “buffet syndrome”. Doctors are therefore placed in this untenable position where we are expected to be prescient and omniscient for every patient seen and every screening lesion detected. Otherwise, we either will not be paid for our services or we will be heavily penalised.