As much as some people would like to believe there is a guideline and a protocol for everything a doctor does, there isn't. We won't get it right every time. The times we don't stick with us and affect us the next time someone with RLQ pain comes in. Is the punishment for not getting it right scanning everyone with RLQ pain? In the defensive world we live in, for many doctors, the answer is yes.
Should it be that way?
You don't even need to lose a lawsuit to practice with this mentality. Heck, you don't even need to get sued. You just have to hear about the trauma other doctors went through practicing competent medicine and being accused of negligence. When you hear about your colleague getting sued for missing that hot appy, despite all your data suggesting otherwise, you will want to scan every RLQ pain, no matter what the data says.
Imagine for a moment if you were driving through a parking lot at 3 mph when a child runs in front of you. You slam on your breaks but you hit him anyway. The child has a massive head injury and lays comatose for the rest of their life. You weren't drunk or stoned. You didn't do anything wrong. Now imagine if the mother of that child sued you for medical bills, pain and suffering related to lost companionship and future lost wages because you were the one who hit her child.
Imagine driving through your entire life worrying that you would get sued for doing everything right, but you just happened to be a party to a bad outcome. Even if you didn't lose the lawsuit, the trauma of the thought of getting sued would consume you daily. You would do everything you could to avoid putting yourself into a position of being sued.
For physicians, that means ordering every test every time in a failed attempt at perfection. A perfection that doesn't exist.