The preparation of the defense of a medical malpractice claim necessarily involves expert review, but there is more here than meets the eye. The focus at trial will be whether there was a violation of the prevailing standard of care by the defendant and whether that caused injury to the patient. All too often the primary focus is placed upon the defense of the liability issues while the defense of proximate cause receives less attention. The defendant surgeon or gynecologist may be of assistance to defense counsel on standard of care and consent issues, but causation defenses may involve the interpretation of radiology and pathology studies or other subjects which are not within the knowledge of the defendant or the expert witnesses in the defendant's specialty. Without full exploration of the causation issues, the defense is ill prepared for trial.