The unnecessary tests are often done for medical-legal reasons (defensive medicine).  Doctors will sometimes try to  limit this when someone is uninsured to keep the patient from going too far into debt. In cases like this I’ll typically offer the tests and then document if the patient refuses.

Suing for nonpayment of bills is far more straight forward than suing for malpractice. Malpractice suits also create a situation which is harmful for everyone (other than the lawyers) as cost of health care is increased.

Having judges as opposed to juries decide might help–but only if the judge has some understanding of the medical issues. Otherwise a judge could also feel sorry for someone and be misled by attorneys,  even if they are less likely to be influenced than juries.

Changes at the point of trial will only help if this dissuades attorneys from taking frivolous suits in the first case. Most cases do not make it to trial due to lack of merit, and of those which do a large number lose. The problem is not just the cases when their is victory with a frivolous suit but the risk of being sued at all. Doctors change behavior not just to avoid suits but to reduce the risk of a frivolous suit being filed at all. Defensive medicine is practiced to have things so well documented with every test in the book that an attorney won’t think it is worth risking a suit.

You misunderstand where defensive medicine comes from. It does not come from any lack of real medical knowledge. It comes from knowing that, even when doctors have followed medical guidelines, plaintiffs have still won cases based upon lawyers convincing juries that doctors should have ordered a certain test. The cost of defensive medicine most certainly does come because of the tort rules and not from any lack of knowledge on the part of the doctor.

Among the reforms which I would want, even more than caps, would be to make following generally accepted medical guidelines an absolute defense, and demonstrating this should prevent the filing of a suit. Some states already have hurdles that must be overcome to weed out frivolous suits even before a suit can be filed, and I would like this added.

I realize that this opens the door for frivolous lawsuits, but I don’t think frivolous lawsuits are as prevelant as tort reform advocates would lead us to believe.  I would also suggest that tort reform will not really change anything with respect to actual care. Care providers careers will still and always be on the line for the decisions they make, so while some may make the argument that defensive medicine practices are the result of doctors conducting tests to save liability dollars, we know instinctively that this is not the case, to the extent it is practiced by doctors, it is done to protect future earnings. And those dollars would still be at risk if the doctor makes avoidable mistakes that cost lives.

A doctor that conducts tests to protect themselves is trading kitchen sink medicine for actual medical knowledge. If the doctor lacks the specific knowledge for why a specific test is unnecessary, they might do the test anyway, but that is not a failure caused by the tort rules, but rather by the doctors lack of knowledge. I will cede that there is an enormous amount of information available and that doctors cannot possibly be aware of all of it, but again, limiting liability will not help to improve this at all.