Here is the first line in a recent AP article about defensive medicine:
CT scans, MRIs and other pricey imaging tests are often more for the doctor's benefit than the patient's, new research confirms.
Boy, that really sounds like physicians just get a major kick out of ordering more studies. As if I had some financial stake in the MRIs I order (a rarity due to the Stark laws). Anyway, this study was the first to get doctors (72 orthopedic surgeons) in advance to track their decisions over time. Doctors checked a box saying a test was either required for clinical care or done "for defensive reasons." Twenty-percent of the time it was for defensive reasons.
To be fair, the AP article does talk a little about malpractice reform but ends with "questions you should ask your doctor before getting any test". Two of them (is it truly needed? do you have a financial stake in the machines that will be used?) are really accusatory and would make for a very awkward relationship.
Defensive medicine exists and the issue with frivolous lawsuits (this includes those without neglect but just bad outcomes) needs to be fixed. Ordering too many tests has some other causes as well. Some doctors are lazy and don't want to work hard. Another reason, I think, is that patients don't have any skin in the game. If they have to pay for the test then it would change the way we do things. Lastly, many patients just want what they want. I have had patients drill me to get surgery, not even an MRI, after two weeks of shoulder pain. Surgery! Many in our society feel we are entitled to anything we want and we want it NOW. All this makes for bad, and expensive, medicine.