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treated in the same way, with the same resources and the same competence in order to achieve the best possible outcome. Based on these theoretical scenarios, evidence-based standards are generally dictated by scientific societies as clinical or technical recommendations. Unfortunately, the real world is exactly the opposite, as every patient requires an individualized decision based on concomitant diseases or therapies, different values and preferences, and availability of technical and human resources. This affects the generalizability of available standards, undermining compliance with current recommendations in clinical practice. When overlooking well-defined standard, the burden of any decision-making process relies on the single professional. When such decisions are associated with substantial risks of morbidity and mortality, some reluctance by professionals may be expected, as it would be they who would be be blamed for any major adverse event. Far from being justified, these personal–when not emotional– reactions generate an irrational excess of diagnostic procedures in an attempt to nullify rather than reasonably decrease any marginal risk. These over-cautious behaviors are ominously known as “defensive” medicine, sadly being reported throughout all the medical and surgical fields. In gastroenterology/endoscopy, this frequently results in an excess of post-endoscopic surveillance, as widely reported in post-polypectomy or Barrett settings. Disappointingly, patients tend to appreciate such an over-zealous approach, triggering a vicious circle between the two main actors of the medical choice. The main danger in “defensive” medicine is represented by the change in perspective between professionals and patients rather than by the mere waste of economic or financial resources. The main benefit of any “defensive” approach accrues to physicians rather than to their patients. In the unrealistic attempt to acquire the full certainty of his or her choice, physicians transfer what should have been their responsibility onto the patients themselves, exposing them to the risks of unnecessary procedures. It could be argued that this is untrue as patients could also get benefit from such obsessive approach. Isn’t it a persuasive belief among patients that an extra exam is better than one fewer? Of course, not! In this issue of EIO, Sonnenberg A et al. show the catastrophic consequences to patient outcome of the “defensive” approach. In both cases, it was the surgeon who inappropriately over-used endoscopic resources to have the highest possible degree of certainty about the correctness of the surgical indication before operating on the patient. What the authors clearly showed – and patients should understand – is that a “defensive” approach increases the complexity of – rather than simplifying – the clinical choice. The more tests you ask the more cumbersome the process becomes for somewhat unpredictable reasons, such as waiting list, need to stop concomitant medications, and lack of adequate resources. In addition, it should be the same professionals who timely analyze all of this information in order to save precious time. However, when dealing with over-busy professionals – such as surgeons or other interventional figures – what happens is that some of them may transfer responsibility for the ultimate choice to another professional, who may, for example, miss the complete clinical picture or may not be trained enough to deal with urgent cases. How to prevent “defensive” medicine? What most physicians miss is that the main reason for which formal recommendations represent the current standard of our profession is not Who benefits from presurgical endoscopic diagnosis: the patient or the surgeon?