On May 22nd 2012, Anaao ASSOMED, which represents the interests of medical staff, and the Tribunale per i diritti del malato-Cittadinanzattiva (Tribunal for Patients' Rights; Cittadinanzattiva), a civic group, presented the results of a study on the long waiting lists experienced by patients in Italy. The two groups examined the problem from the stance of both members of the public and doctors. A joint statement was issued, which noted: “The problems that waiting lists create for physicians and the public are common across most public health services in Europe and the world, and have complex causes. In Italy, attempts have been made (through planning reforms and legislative changes) to reduce waiting lists, but with poor results." The two groups identify contributory factors behind lengthening waiting lists as clinically-inappropriate use of diagnostic imaging; a rapid rise in demand for medical care in Italy, fuelled by access to healthcare information via the Internet; the practice of defensive medicine [Ed: doctors practising in such a way as to avoid facing a lawsuit]; and epidemiological changes in the landscape of disease. Thus far, the Italian healthcare system has reacted to long waiting lists by promising greater investment to compensate for shortages of healthcare professionals—but without considering the real causes of longer waiting lists. Shortages in medical staff probably account for no more than a third of waiting lists. Francesca Moccia, National Coordinator of the Tribunale per i diritti del Malato/Cittadinanzattiva, noted that waiting lists for diagnostic tests continue to rise, particularly in cardiology, gynaecology and obstetrics, oncology, ophthalmology, orthopedics, and urology. Furthermore, the decentralized nature of the Italian healthcare system means that Italian patients face different lengths of waiting time nationwide—a fact, insists, Ms Moccia, that undermines the principle of universal access to healthcare.