I'm Defense specced and wear my tanking gear all the time.
For normal/strong packs, I use Kira in her armor penetration stance. With decent gear, she tears through normal mobs nearly as fast as I do.
For elite/champion mobs, I use Doc in his Med Watch stance. So long as whatever I'm fighting is interruptable and doesn't have an enrage timer, I can wear them down with Doc keeping me healthy.
If I'm feeling extremely lazy, I'll use Doc in his Blaster Stance. This way he keeps me topped off and throws some extra damage at whatever I'm fighting.
I don't use any other companions. As a tank, I don't have a use for T7 or Scourge, and Rusk was underwhelming when I used him.