Waxman et al. (Oct. 16 issue)1 state that malpractice reform has had little effect on the ordering practices of emergency department physicians, and they speculate that physicians may perceive the effects of potential litigation on ordering practices to be far greater than they actually are. An alternative explanation of their findings may be that, once the custom of ordering tests that may be marginally indicated but performed because of malpractice considerations has become ingrained, it is difficult to break the habit of such ordering practices, even when litigation is no longer a consideration. The reflex of ordering computed tomography or magnetic resonance imaging may still be active under many circumstances. Certainly, habits can become very difficult to break regardless of the original stimulus.