There's also the perverse incentives in the american medico-legal system: surgeons get sued for not performing surgery, or performing surgery badly, but they rarely get sued for performing 'unnecessary' surgery unless its completely egregious. If the patient has a history/examination which could indicate a need for surgery, and the patient has given informed consent, the surgeon is very unlikely to be succcessfully sued for operating. I'm not implying this is a consious decision on their part, rather a subconscious influence of their training, anecdotes from other surgeons etc.