DS works in a clinic that caters for medicare patients, many of whom arrive in terrible shape for their first appointment - blood pressure through the roof, dangerous oedema, out of control diabetes, gangrenous feet. Many are taken straight from the clinic to the hospital down the street by ambulance for same day surgery. They are in terrible shape for a number of reasons, some institutional and some personal to them. Some have gone to incompetent doctors in the past. Some have gone to good doctors but have disregarded medical advice, refused to fill prescriptions, etc. Hence one woman last week who was rushed to the hospital to get her leg amputated thanks to complications from diabetes.
One of DS's duties is to go through every patient's entire medical record - as much as is available - and check that all possible tests have been done, check family medical issues noted, check what medications have been prescribed and diagnoses made over what is often decades worth of medical history. The reason to do this is to facilitate proper treatment and to see if further testing is indicated. The business model of the clinic favours health maintenance over emergency intervention, which is far more costly. So they invest time in testing, in impressing on the patients how important it is to take the Metformin or the asthma medication or the blood pressure pills. They have a dietitian on staff. The clinic is paid by Medicaid.
Testing is a good thing. Doctors in general do not order tests to keep from making a decision but to facilitate the right decision. All testing has to be run past the insurance company that pays for it. Insurance companies have a vested interest in keeping costs of treatment low.
All health insurance companies develop treatment protocols that doctors and surgeons have to follow or fight against when considering treatment and testing options. My late FIL was a neurosurgeon with an Ivy League undergrad and medical education who complained bitterly about debating the pros and cons of a course of treatment with some nurse employed by the insurance company. Sometimes he had to persuade the insurance company rep that tests were not needed because all indications showed X or Y problem. Sometimes he had to beg for tests to be allowed.
Doctors can be sued no matter what the circumstances. A doctor can choose to tell the patient that they can no longer treat a patient who is non-compliant or wants to use boiled herbs instead of chemotherapy or blood pressure medication, etc. and many do that because the alternative is the cost and time spent dealing with family members and their lawyers afterwards.