Overtreatment

• Overtreatment involves medical services that offer no net benefit or may cause harm.
• It can lead to physical harm, psychological distress, and significant financial burden.
• Common examples include unnecessary diagnostic screenings, tests, and procedures.
• Patients can reduce their risk of overtreatment by seeking second opinions and asking informed questions.
• Healthcare systems strive to balance thorough care with avoiding unnecessary medical interventions.

What is Medical Overtreatment?

Overtreatment refers to the provision of medical care that is not justified by clinical evidence, does not improve a patient’s health outcomes, or may even cause harm. It encompasses a wide range of practices, from excessive diagnostic testing to unnecessary surgical procedures or medication prescriptions. The core issue is that the potential harms or costs of the intervention outweigh any potential benefits for the patient.

Understanding what is medical overtreatment is crucial for both patients and healthcare professionals. It often stems from a combination of factors, including defensive medicine (to avoid malpractice suits), patient demand for “doing everything possible,” financial incentives within the healthcare system, and a lack of clear guidelines or evidence for certain conditions. The goal of quality healthcare is to provide appropriate, evidence-based care, and overtreatment deviates from this principle.

Examples of overtreatment in medicine are varied and prevalent across different specialties. For instance, routine imaging for low back pain without “red flag” symptoms often leads to findings that are not clinically significant but can prompt further unnecessary investigations or interventions. Another common scenario involves aggressive cancer screenings in very elderly patients with limited life expectancy, where the potential harms of screening and subsequent treatment (e.g., biopsy, surgery, chemotherapy) may far outweigh the benefits. Similarly, antibiotic prescriptions for viral infections, which are ineffective, contribute to antibiotic resistance and expose patients to unnecessary side effects.

Risks and Dangers of Overtreatment in Healthcare

The dangers of overtreatment in healthcare extend beyond financial costs, impacting patient well-being in multiple ways. Physically, unnecessary tests can expose patients to radiation (e.g., CT scans), while unneeded surgeries carry risks of infection, bleeding, and complications from anesthesia. Medications prescribed without clear indication can lead to adverse drug reactions or interactions. Psychologically, false positives from excessive screening can cause significant anxiety and distress, even if subsequent tests prove benign. The diagnostic cascade, where one unnecessary test leads to another, can trap patients in a cycle of medical interventions.

Economically, overtreatment places a substantial burden on individuals and healthcare systems. A study published in JAMA estimated that approximately 25% of healthcare spending in the United States, or between $760 billion and $935 billion annually, is wasteful, with overtreatment being a significant contributor. (Source: Shrank WH, Rogstad TL, Parekh N. Waste in the US Health Care System: An Insured Population Analysis. JAMA. 2019;322(15):1501-1509). This waste diverts resources that could be used for genuinely beneficial care, increasing insurance premiums and out-of-pocket expenses for patients.

How to Avoid Overtreatment: Strategies and Examples

Empowering patients and fostering open communication are key strategies for how to avoid overtreatment by doctors. Patients should feel comfortable asking questions and seeking clarification about recommended tests, procedures, or treatments.

Here are some practical strategies:

• Ask “Why is this necessary?”: Understand the rationale behind any proposed intervention, including its benefits, risks, and alternatives.
• Seek Second Opinions: Especially for major procedures or diagnoses, consulting another physician can provide a different perspective and confirm the necessity of treatment.
• Be Informed: Research your condition and treatment options from reputable sources. Organizations like Choosing Wisely provide evidence-based recommendations on tests and procedures to question.
• Communicate Your Preferences: Share your values, goals, and concerns with your doctor. If you have a limited life expectancy, for instance, you might prioritize comfort over aggressive interventions.
• Maintain a Comprehensive Medical Record: Keep track of your medical history, tests, and medications to avoid duplicate procedures or conflicting treatments.

For example, if a doctor recommends an MRI for routine lower back pain without neurological symptoms, a patient might ask about the evidence supporting this, potential alternatives like physical therapy, and the risks involved. Similarly, if an elderly patient is advised to undergo a rigorous screening schedule for a slow-growing cancer, they could discuss their overall health, life expectancy, and personal preferences regarding quality of life versus aggressive treatment. By actively participating in their healthcare decisions, patients can significantly reduce their risk of receiving unnecessary care.