Modern medicine can harm people not only by missing disease but by finding and treating too much of it.1Kristen Sparrow, MD. Reducing Iatrogenic Damage: First, Do No Harm Much of what drives this is built into how healthcare is paid for, regulated and sold, not just into individual doctors’ choices.
What Counts as Too Much Medicine
Overtreatment is a treatment that doesn’t benefit you, or whose risk of harm likely outweighs any benefit.2PubMed Central. The Pitfalls of Overtreatment: Why More Care is not Necessarily Beneficial Overdiagnosis is being labeled with a disease that would never have harmed you.3PubMed. Incidental Findings and Low-Value Care Doctors and researchers call tests and treatments that add cost and risk without real benefit low-value care.4PubMed. A Framework for Measuring Low-Value Care
An overdiagnosis is technically correct: the abnormality really is there. The problem is that it would never have caused symptoms or shortened your life. A misdiagnosis is simply wrong, while an overdiagnosis is right but unhelpful.
One way overdiagnosis happens is when the line for calling something a disease is set so low that many people without harmful disease cross it, as has been argued for some chronic kidney disease diagnoses.5PubMed. Getting clearer on overdiagnosis Many conditions are defined by a number on a lab test or measurement. Mild results near the line often stay stable for years, so your report may flag a value as abnormal even when it carries little risk at your age.
Money, Lawsuits and Marketing Push Care Upward
In fee-for-service payment, doctors and hospitals are paid for each test or procedure they perform.6Fierce Healthcare. Medical overuse and why fee for service must go High-profit services like CT scans and ultrasounds tend to be overused, while low-profit care like counseling is underused.7Fierce Healthcare. Medical overuse and why fee for service must go A clinic can bill for a scan in minutes, while a long conversation about whether to wait is often poorly paid.
Fear of lawsuits adds to the pull. In one national survey of US neurosurgeons, 72% ordered scans, 67% ordered lab tests and 66% called in other specialists purely to protect themselves from lawsuits.8PubMed Central. Malpractice Liability and Defensive Medicine: A National Survey of Neurosurgeons Tests ordered mainly to reduce legal risk have been estimated to cost the US tens of billions of dollars, about $55.6 billion in 2008 alone.9PubMed Central. Malpractice Liability and Defensive Medicine: A National Survey of Neurosurgeons Yet there’s little evidence that the lawsuit system actually makes care safer.10PubMed Central. Defensive Medicine: A Case and Review of Its Status and Possible Solutions If a doctor orders a test “just to be safe,” you can ask what the doctor expects to find and how the result would change your treatment.
Drug companies, sometimes with doctors and patient groups, have widened the boundaries of conditions to expand markets for medicines.11HAI Health Action International. Disease-mongering Awareness campaigns often present conditions as common, serious and treatable while leaving out doubts about the condition and the drugs’ costs and harms.12HAI Health Action International. Disease-mongering The arrival of new drugs, and potentially genetic treatments, increasingly drives the creation of new medical categories.13PubMed. The shifting engines of medicalization
To read a disease awareness ad critically, notice whether it says how many people truly benefit from treatment, and whether side effects and uncertainty get real space. A quiz suggesting “you may have” a condition is a sales tool, not a diagnosis. If an ad strikes a chord, talk it over with a doctor who isn’t tied to the advertised product.
Sharper Scans Find Things Nobody Was Looking For
An incidental finding is something a scan spots that has nothing to do with why you were scanned. They are common: about 15 to 30% of all imaging and 20 to 40% of CT scans show at least one.14PubMed. Incidental Findings and Low-Value Care Widespread CT and MRI use has raised detection of small adrenal gland lumps nearly tenfold over two decades.15PubMed Central. Evaluation of adrenal incidentalomas: Current approaches, caveats, and unexplored issues Findings range from harmless quirks to real, unsuspected disease that changes treatment.16IECCMEXICO. Incidental Imaging Findings: Risk Stratification, Timely Diagnosis, and Clinical Decision-Making
Part of the reason is that newer machines resolve much smaller structures than older ones. Lumps and spots that were always present in many healthy people now show up on the image. Many of these small features are common in people with no symptoms, so seeing one does not mean something is going wrong in your body.
After a scan flags something unexpected, the report may recommend a follow-up scan in a few months. Further tests can include more radiation, biopsies or specialist visits, and each step carries its own small risk and stress. It’s reasonable to ask how likely the finding is to be harmless and what waiting would mean.
For people at low risk, chasing incidental findings often creates an illusion of benefit while causing harm.17PubMed. Incidental Findings and Low-Value Care That includes cancers that are truly malignant yet would likely never have affected the person’s health.18PubMed. Incidental Findings and Low-Value Care Catching them makes survival statistics look better without anyone living longer, and treating them brings surgery or drug side effects with no gain.
Home wearables can do the same. Continuous heart-rhythm monitoring nearly tripled atrial fibrillation diagnoses and doubled blood-thinner use without reducing strokes or other bad outcomes.19PubMed Central. Overdiagnosis in atrial fibrillation screening with wearables
Patients Ask for More Too
In one study of primary care visits, 56% of patients came expecting at least one test, referral or new prescription, and a quarter expected two or more.20PubMed Central. Do Unmet Expectations for Specific Tests, Referrals, and New Medications Reduce patients’ Satisfaction? That expectation can change what gets treated. When patients in clinics in Mali were told directly about a discount on malaria pills, overall malaria treatment rose about 10%.21American Economic Journal: Applied Economics. Does Patient Demand Contribute to the Overuse of Prescription Drugs? But the extra patients treated rarely had malaria, so medicine went to people who didn’t need it.22American Economic Journal: Applied Economics. Does Patient Demand Contribute to the Overuse of Prescription Drugs?
Doing something often feels better than waiting. A prescription or scan feels like proof the visit mattered, while being told to wait and watch can feel like being dismissed. Yet watchful waiting is an active, deliberate plan for many problems that clear up on their own.
If something worries you, describe the worry rather than naming the test you want. Ask what the doctor thinks is most likely and why, and what signs would mean coming back sooner.
The Emotional Toll of False Alarms
After a false-positive lung cancer CT screen, people had more anxiety, low mood and self-blame a week later than those with clear results.23PubMed Central. Psychosocial consequences of false positives in the Danish Lung Cancer CT Screening Trial: a nested matched cohort study People with a positive stool test for bowel cancer still felt distressed 6 weeks after a normal colonoscopy.24PubMed. FIT false-positives in colorectal cancer screening experience psychological distress up to 6 weeks after colonoscopy Women with false-positive mammograms still had intrusive thoughts about breast cancer and felt at higher risk a year later.25PubMed. False-positive findings in mammography screening induces short-term distress – breast cancer-specific concern prevails longer Overdiagnosis of prostate cancer brings anxiety plus the risk of treatment side effects.26PubMed Central. Overdiagnosis of Prostate Cancer
The wait between a callback and follow-up can be days of fear, and stress is often highest in that gap before the answer. Knowing in advance how often callbacks turn out fine can soften the shock. Before a screening test, it helps to ask how often it gives a false alarm, what would happen next if it comes back positive, and how likely it is to find something that would never have harmed you.
When One Pill Leads to Another
Taking many medicines at once, usually five or more, is common in older adults.27PubMed. Polypharmacy Management in Older Patients It often leads to drug interactions, toxicity, falls with injury, confusion and missed doses.28PubMed. Polypharmacy Management in Older Patients It is also linked with more hospital stays and higher costs.29PubMed. Polypharmacy Management in Older Patients
Older adults are more likely to have several long-term conditions, and each may be managed by a different specialist who adds a prescription. Kidneys and liver clear drugs more slowly with age, so a dose that suited you years ago can build up to a level that causes problems. Symptoms like dizziness, tiredness or confusion are easily put down to “getting older,” which makes a drug side effect easy to miss.
That sets up a prescribing cascade: a drug’s side effect is mistaken for a new condition and treated with another drug.30Preprints. Prescribing Cascade as a Therapeutic Error: A Danger for Geriatric Patients with Multimorbidity Because older bodies process drugs differently and have less reserve, they’re more vulnerable to side effects, including kidney damage.31Preprints. Prescribing Cascade as a Therapeutic Error: A Danger for Geriatric Patients with Multimorbidity Cascades can worsen health and quality of life and lead to more hospitalizations.32Preprints. Prescribing Cascade as a Therapeutic Error: A Danger for Geriatric Patients with Multimorbidity
A typical chain: a new blood pressure pill causes ankle swelling. The swelling is treated with a water pill, which causes dizziness. The dizziness leads to a fall or yet another prescription. Each doctor may see only one piece of the chain.
A brown-bag review can break it. Bring every pill, supplement and cream to one appointment, and ask whether each is still needed and what it’s for. Ask whether any new symptom started after a new drug. Never stop a medicine on your own, since some need gradual tapering.
Normal Life Events Turned Into Medical Ones
In one study of healthy women, 94.6% had some form of intervention during labor and birth.33PubMed. Exploring the medicalisation of childbirth through women’s preferences for and use of pain relief First-time mothers used more pain-relief drugs than they had planned, and more interventions were linked with lower satisfaction with the birth.34PubMed. Exploring the medicalisation of childbirth through women’s preferences for and use of pain relief In a study of low-risk pregnancies in Iran, 67% of women gave birth by cesarean section.35PubMed Central. Assessment of Medicalization of Pregnancy and Childbirth in Low-risk Pregnancies: A Cross-sectional Study
For a birth plan, ask your provider which interventions are routine and which are needed only for specific problems. Ask what the hospital’s cesarean rate is for low-risk births. Plans can change for good reasons; the aim is informed choices, not refusing care.
Costs That Reach Everyone
More than 30% of US health spending has been estimated to be wasteful, with low-value care a major part.36PubMed. A Framework for Measuring Low-Value Care That money isn’t available for care that helps, and unneeded care raises insurance premiums and out-of-pocket costs.
Overuse of antibiotics has also sped up the spread of drug-resistant bacteria worldwide.37PubMed Central. Antimicrobial resistance: risk associated with antibiotic overuse and initiatives to reduce the problem Resistant bacteria cause more severe infections, complications, longer hospital stays and more deaths.38PubMed Central. Antimicrobial resistance: risk associated with antibiotic overuse and initiatives to reduce the problem
Antibiotics don’t work against colds, flu or most sore throats, which are usually caused by viruses. Taking them anyway brings side effects like diarrhea with no benefit. “Is this bacterial?” is a reasonable question at any visit.
How Overuse Can Be Reined In
Choosing Wisely is a campaign listing tests and treatments doctors often don’t need. Just publishing these lists rarely reduces low-value care.39PubMed Central. The Impact of Choosing Wisely Interventions on Low‐Value Medical Services: A Systematic Review Active programs succeeded 65% of the time versus 13% for simply spreading the advice.40PubMed Central. The Impact of Choosing Wisely Interventions on Low‐Value Medical Services: A Systematic Review Programs combining several approaches, such as reminders, feedback and education for doctors, worked best, 77% versus 47%.41PubMed Central. The Impact of Choosing Wisely Interventions on Low‐Value Medical Services: A Systematic Review
Media coverage matters too. News stories often present uncertain new diagnoses as settled; in one analysis of coverage of the eating-related label orthorexia, 58% did so.42Journalism Practice. Medicalization in the Media: News Coverage of a New and Uncertain Diagnosis Treat headlines about a newly named condition with caution.
For you, five questions cover most situations before any test or treatment. Do I really need this, and what will it change? What are the risks and side effects? Are there simpler or safer options? What happens if I wait or do nothing? How much does it cost?
New, severe or worsening symptoms still deserve prompt care.