Unnecessary medical interventions, known in the medical world as overtreatment and overdiagnosis, represent one of the biggest and most expensive problems of modern healthcare systems. These are tests, procedures, operations, and medications that are performed or prescribed to patients even though they bring them no real benefit, and often cause serious harm, ranging from side effects of drugs, postoperative complications, infections, and unnecessary radiation exposure, all the way to significant financial costs that fall on patients and their families, as well as on the entire healthcare system.
This issue is not only medical but also economic, ethical, and social. Research shows that the problem exists in all countries, regardless of their level of economic development. In wealthy nations as well as in developing countries, overtreatment has become a systemic phenomenon. According to some estimates, unnecessary medical care costs hundreds of billions of dollars annually in the United States alone, with similar patterns appearing in other healthcare systems.
How Big Is the Problem Really?
According to a survey conducted among more than 2,000 American physicians in 2017, doctors estimate that 20.6 percent of all medical services are unnecessary. This includes 22 percent of prescribed medications, 24.9 percent of diagnostic tests, and 11.1 percent of procedures. 
In everyday practice, this looks like the following: MRI or CT scans for ordinary, non-specific back pain (which in most cases resolves on its own within a few weeks), routine preoperative blood tests and other analyses for completely healthy patients undergoing minor surgery, placement of stents in stable angina pectoris, hysterectomies without clear medical indication, vertebroplasties (“cementing” of vertebrae) for osteoporotic fractures, or the massive use of antibiotics for ordinary viral colds.
Global systematic reviews show that overuse of diagnostic tests ranges from 30 to 97 percent, depending on the type of test. These procedures not only fail to help but often lead to new, more serious problems: allergic reactions to medications, postoperative infections, unnecessary radiation that increases the risk of cancer, or even complications that require additional treatment and prolonged hospital stays.
Fear of Lawsuits and “Defensive Medicine”
The most common reason for this phenomenon is not greed, but fear of lawsuits. In the mentioned survey, as many as 84.7 percent of doctors cited fear of making a mistake as the main motive for unnecessary interventions. Doctors often do “more than necessary” simply to protect themselves in case something goes wrong, even when they know that the real risk of being sued is very small, only 2–3 percent of patients who believe a mistake was made actually file a lawsuit.
This phenomenon, known as “defensive medicine,” is particularly pronounced in surgery, obstetrics, orthopedics, and cardiology. Older surveys show that as many as 91 percent of doctors believe that concern about potential lawsuits leads to superfluous tests and procedures. The consequence is enormous: billions of dollars wasted on unnecessary interventions, while patients are exposed to risks without any real reason.
Money as an Incentive: Doctors’ Earnings and the Influence of Pharmaceutical Companies
Financial motives also play a significant role. In a system where payment is made “per service performed” (fee-for-service), hospitals and doctors earn more when they perform more tests, scans, or operations. As many as 71 percent of doctors believe that their colleagues are more inclined to unnecessary procedures precisely when they benefit financially from them. Experts estimate that around 17 percent of unnecessary interventions come from this reason.
The influence of pharmaceutical companies on doctors is particularly pronounced. When doctors receive gifts or consulting fees, attend conferences and trips paid for by pharmaceutical firms, they significantly more often prescribe their (often more expensive) drugs instead of cheaper alternatives. This happens most frequently with antibiotics, cholesterol medications, opioids, and new expensive oncology therapies.
It’s Our Fault Too
Patients very often demand or even strongly insist that “everything possible be done,” because they firmly believe that a greater number of tests, scans, laboratory analyses, and medications automatically means better, more thorough, more modern, and safer medical care. Many patients and their families think that if a doctor does not order additional examinations or prescribe another drug, then “he is not doing his job properly.”
This pressure from patients and their loved ones is extremely strong, as many as 59 percent of doctors openly cite it as an important reason for performing unnecessary interventions.
To all this we must add the deeply rooted culture in modern medicine that “more always means better,” which has been built over decades through education and practice. Finally, there is the human factor, the desire of doctors to present themselves well professionally, to perform well in evaluations, not to be criticized by colleagues, and to meet the expectations of hospital or clinic management.
Are There Solutions? The “Choosing Wisely” Campaign and the Way Forward
Fortunately, there are concrete and successful solutions in the world. The best-known international initiative is Choosing Wisely (“I Choose Wisely”), launched in 2012. More than 70 specialist associations in over 20 countries have published lists of “5 Things Physicians and Patients Should Question”, specific procedures that are often performed without need (e.g., routine preoperative tests, antibiotics for viral colds, etc.).
In countries where it has been implemented, the campaign has reduced certain unnecessary interventions by 20–40 percent. Other possible solutions include better education of doctors and patients, changes to the payment system (fixed payment per patient instead of per procedure), stricter clinical protocols and their regular updating, and better legal protection for doctors from unfounded lawsuits.
Photo:Magnific
