"defensive medicine"

I was just reading an estimate of the costs of "defensive medicine", defined as unnecessary tests and procedures physicians order to protect themselves from lawsuits, as $44 Billion. I'm still trying to determine where that and similar numbers come from. Assuming defensive medicine exists for this post, how is this number possible?

My understanding is that all testing, unless something simple like a blood test, and procedures require informed consent. Informed consent/informed patient choice is sought and given for treatment that is appropriate, necessary, and desired by the patient. If informed consent is sought for treatment that is inappropriate or unnecessary, how does a physician explain that to a patient in order to get infomed consent?

Rather than stating that billions are spent (wasted) on unnecessary or inappropriate or unwanted tests and procedures and using that informaton as evidence that SOMETHING must be done about medical mapractice litigation, shouldn't we look at what is underneath those numbers? How are physicians getting informed consent to do these procedures? If they are handing a form to a patient and asking that it be signed, without discussion, explanation, and joint decision-making, there is no informed consent. Shouldn't that be the issue we address?

In an earlier post, I talked about statistics cited by Mayor Bloomberg regarding the shocking number of C-sections performed that are unnecessary. Are there "informed" consents for these staggering numbers? What information is provided? What alternatives are discussed? What conversations are held? What warnings/concerns are expressed? What time is given for the patient to consider all options before signing?

Shouldn't we set aside the conversation about defensive medicine and consider the one-on-one conversations between patients and physicians that need to truly inform patients? If patients are not being appropriately informed, new processes/laws need to be in place to change that. Once patients are appropriately informed and are given the choice about the procedure/testing, there will be a lot less "defensive medicine". Patients will be equal partners in decision-making and won't be agreeing to procedures and testing they don't need. Hence, even if physicians want to do testing to protect themselves, patients won't agree.

It makes perfect sense, so, let's get busy!!!.