As a physician, you are wired to help a patient when they ask for help. The trouble is that modern healthcare often rewards doctors for doing more, even when doing more is not necessarily doing better. Order another test. Add another prescription. Refer again. Image again. “Just to be safe”.
Medicine has always lived in the gray zone between cautious and excessive. But today, the gray zone has billing codes, quality metrics, patient satisfaction surveys, malpractice risk, and private companies selling full-body MRIs to healthy people who rush to the clinic for every cough or sneeze.
In a recent poll of over 600 physicians, Sermo asked “Do you believe that overtreatment is a significant issue?”
A strong majority—63%—agreed yes, citing its significant role in driving up healthcare costs, while 23% also said yes, pointing to increased health complications. Just 9% viewed overtreatment as an issue but not a major one, and only 3% dismissed it as no concern at all.
Overtreatment is a healthcare system and market demand problem that becomes symptomatic when patients come in for an appointment. In the Sermo community, physicians describe a profession caught between patient expectations, defensive medicine, corporate revenue pressure, limited visit time, and the uncomfortable reality that some clinical decisions only look unnecessary after the outcome is known.
Physicians are not denying the problem. They are asking for a more honest conversation about why it happens, how it harms patients, and what can realistically be done without exposing doctors. This article shares physician insights and what you can do to reduce unnecessary care without compromising patient outcomes.
What is overtreatment and how common is it in medical practice?
Overtreatment refers to medical interventions that do not benefit the patient, or where the risk of harm outweighs the likely benefit. According to a physician survey published in the International Collegiate Journal of Science, physicians estimate that around 20% of overall medical care is unnecessary, including 24.9% of tests, 22% of prescriptions, and 11.1% of procedures.
The most commonly cited drivers include fear of malpractice, patient pressure, and difficulty accessing prior medical records. Overtreatment is estimated to cost the U.S. healthcare system $282 million annually.
Related concepts to overtreatment include overdiagnosis, where a condition is detected that would never cause harm; overtesting, where diagnostic workups exceed clinical need; and overuse, where services are delivered despite limited or no expected value. According to a PubMed Central review, overtreatment can account for up to 30% of healthcare costs and is increasingly recognized across clinical and scientific communities as a widespread problem.
Common overtreatment examples include:
- Routine imaging for uncomplicated low back pain
- Unnecessary preoperative testing in low-risk patients
- Antibiotic prescriptions for viral infections
- PSA screening without shared decision-making
- Cardiac procedures unlikely to improve outcomes
Physicians in a national survey by Johns Hopkins University approximated that one in five medical interventions is unnecessary. The same research found a documented “blind spot”: 64.7% of physicians believed at least 15% to 30% of care was unnecessary, but many were more likely to identify wasteful care in colleagues’ practice patterns than in their own.
Physicians on Sermo describe the consequences in clinical rather than abstract terms. A Sermo member practicing in infectious disease shares, “Overtreatment and the use and abuse of health technology, both for diagnosis or treatment, such as the abuse of antibiotic therapy, has caused unnecessary costs for health systems as well as for patients and their families. One of the main consequences has been antimicrobial resistance, which is why it is very important to use the tools and techniques of quaternary prevention to prevent these effects.”
A cardiologist in the U.S. put it bluntly, “Overtreatment is a definite issue in the US healthcare system. Part of this is a medicolegal issue where providers overorder tests out of fear of legal repercussions if something is missed. Overuse of antibiotics is another issue driven by patient demands, the need to meet quality metrics, and the culture of medicine. The consequences are both worse health outcomes and increased costs.”
“I’m sure that part of the problem is the drive, particularly by the mega healthcare groups, to maximize profit. That is a facet that only analysis of the groups over time will provide, and penalties should be imposed. The other side of the issue is more problematic. What happens when there is borderline concern on the part of the healthcare provider that a procedure is warranted even though it may not quite meet the criterion used? In hindsight, the procedure may prove to have been an unnecessary expense, but at the time, things may have been less clear-cut. Only retrospective studies can clarify whether it is poor judgment on an isolated issue or a pattern of abusive spending, and by then, the money has already been spent,” writes a pediatrician on Sermo.
How can physicians recognize when they are overtreating?
36% of surveyed physicians on Sermo feel that market-based healthcare is the main driver of overtreatment, with an additional 44% agreeing it contributes.
With this in mind, what are physicians supposed to do? What does it feel like when you are ordering a test you know might not be necessary? Often, it feels like self-protection. It feels like a patient who will not leave reassured. A family member demanding “everything.” A missing outside record. A prior lawsuit still living rent-free in your mind. Or a system constantly reminding you that RVUs do not generate themselves.
These everyday triggers—malpractice fear, patient demands, revenue pressures, corporate targets, and record gaps—drive overtreatment.
Defensive medicine
Defensive medicine remains one of the clearest drivers of overtreatment. In the national physician survey on overtreatment in the U.S., 84.7% of physicians cited fear of malpractice as a top reason for overtreatment. Sermo’s own resource article on defensive medicine defines it as care motivated more by fear of liability than patient benefit, including extra tests, imaging, labs, or referrals ordered to document that every possibility was considered.
“In the past, overtreatment and excessive testing were used to prevent the missed or delayed diagnosis and thus malpractice. Now it seems to be due to less educated “providers” doing unnecessary overtesting and treatment. In our country, the bulk of costs are in the last 6 months of life,” writes an internal medicine physician on Sermo.
In your next decision, pause to ask yourself “What specific finding from this test would change management?” Ask whether you are ordering a test to find something or to record that you looked. The latter is a hallmark of defensive medicine.
Patient pressure
Pressure from patients (and their families) is another major force. The same physician survey found that 59% cited patient requests as a driver of overtreatment. Patients increasingly arrive with internet-sourced diagnoses, direct-to-consumer testing, social media anxiety, and expectations shaped by advertising.
An OBGYN further explains, “I believe that currently there is an overuse of health resources since patients have access to a lot of false information on the Internet and many times they go to the doctor inventing symptoms in order to obtain certain exams, also the most recent generations of doctors forget the essence of medicine, which is the interrogation and physical examination.”
Recognizing when patient demand — rather than clinical need — is driving a decision is a skill that requires deliberate practice. Saying no is clinically appropriate, but it is rarely quick. When a patient requests a test, explain what it can and cannot show, what you would do with a positive result, and what the risk of the test itself is.
Fee-for-service incentives
Fee-for-service incentives can also influence care patterns. A large majority of physicians in the study believed doctors are more likely to perform unnecessary procedures when they profit from them, and most believed de-emphasizing fee-for-service compensation would reduce utilization and costs.
When revenue and clinical judgment are aligned, it’s easy to miss where one is quietly overriding the other. Benchmark your utilization against peers. Many EHR and payer systems provide specialty-level comparison data. If your ordering rates for certain tests or procedures consistently exceed peers, investigate why.
Corporate ownership
Private equity and corporate ownership also amplify this pressure. A Health Forum study in the Journal of the American Medical Association found that after a private equity acquisition, physician practices in dermatology, gastroenterology, and ophthalmology experienced increases in spending and utilization, including higher charges per claim.
Physicians on Sermo witness the culmination of these overtreatment factors at work. A Sermo member describes the reality, “The unnecessary use of resources not only affects from an economic point of view. There are invasive procedures that, sometimes, when the criteria for their performance are not met, adversely affect the patient’s health. One of the most common examples observed in routine clinical practice is the patient’s request for a chest X-ray, in the case of viral processes, or pathologies related to the chest wall, where the X-ray has no diagnostic value.”
How physicians can reduce overtreatment in clinical practice
Reducing unnecessary medical treatment does not require physicians to become nihilists in white coats. It requires practical restraint, clear communication, and defensible documentation.
In a Sermo poll asking, “What do you feel can be done about overutilization?” physicians responded with
- 38% favoring more clear treatment guidelines (which you can apply directly in your consultations to guide patient-specific decisions),
- 30% calling to eliminate patient satisfaction-based reviews and reimbursement (prompting you to prioritize evidence over external pressures in your billing and care choices), and
- 24% advocating greater focus on value-based care (which you can embrace by measuring outcomes in your own practice).
Apply evidence-based appropriateness criteria
The Choosing Wisely Initiative, launched by the American Board of Internal Medicine, brought together more than 80 specialty society partners and produced more than 700 recommendations identifying overused tests and treatments. A BMC Primary Care study of Norwegian GPs found that Choosing Wisely was viewed as useful by many GPs. Although the campaign ran from 2012 to 2023, the ABIM Foundation notes that its recommendations remain part of a large body of work helping clinicians and patients discuss unnecessary care.
The American Academy of Family Physicians also maintains a Choosing Wisely recommendations collection, which can help physicians identify low-value care patterns in their specialty. For example, you can reduce overtreatment by including avoiding imaging for low back pain within the first six weeks unless certain criteria are met.
Practice shared decision-making
When a test or treatment has potential value, shared decision-making gives patients the information they need to weigh benefits, risks, and uncertainty. As an individual physician, you can reduce overtreatment by translating the clinical tradeoff clearly enough that the patient can participate in deciding on which tests are worth it.
Improve access to complete medical records
Fragmented records drive repeat testing. In the Johns Hopkins University survey, 38.2% of physicians cited difficulty accessing medical records as a reason for overtreatment. When physicians cannot see what has already been done, repeating the workup can feel safer than trusting incomplete information. Doing your part to maintain complete and accurate records can help in reducing overtreatment, making it easier for yourself and colleagues to avoid duplicates.
Question self-referral patterns
Physicians should be honest about whether financial incentives are affecting clinical decisions. Audit your own motives and thresholds. This does not mean every profitable procedure is inappropriate, but if your threshold for intervention changes when revenue flows back to the practice, that is not clinical judgment.
Use documentation as your primary line of defense
Documentation is your clinical reasoning made visible. Sermo’s guide on physician liability in medical malpractice emphasizes that malpractice claims generally require duty, breach, causation, and damages. Negligence is evaluated in context, not through the fantasy lens of perfect hindsight. You can reduce overtreatment risks by using clear documentation in every case to demonstrate why the care provided met the standard under the circumstances.
Train the next generation
55.2% of national survey respondents identified training residents on appropriateness criteria as a top solution to overtreatment. As a physician mentor, you can reduce overtreatment by teaching restraint as a clinical skill that can be practiced, not a personality trait reserved for a select few.
Talk to peers
Overtreatment is a topic many physicians think about but rarely feel comfortable discussing. Secure peer discussion on Sermo helps physicians compare thresholds, challenge local norms, and identify what the standard practice really is in modern day. You can reduce overtreatment in your practice by participating in these Sermo discussions to refine your own decision-making.
A trauma surgeon summarizes on Sermo, “I think the solution is really to focus on staying up to date with treatment innovations and knowing the adverse effects of each one in order to be able to apply the treatment in a personalized way according to the requirements of each individual patient. Taking into account your comorbidities (if present).”
How overtreatment affects physicians: burnout, moral distress, and clinical consequences
Overtreatment is usually discussed as a cost problem, a waste of resources, or a patient safety issue, as confirmed by a Sermo poll where these factors were at the top of the list with 40%, 33% and 23% of the vote respectively. But for physicians, it can also be a moral distress problem.
Patients suffering from overtreatment is well documented. Physical harm from unnecessary procedures, antimicrobial resistance, radiation exposure, financial harm from out-of-pocket costs, psychological harm from false positives and disease labeling, and cascading workups that consume time and resources.
The harm done to physicians is quieter. It is the burden of knowing the test is probably unnecessary and ordering it anyway. It is the hit to your clinical confidence that comes from tip-toeing through a healthcare system that conflicts with your judgment because the system makes the alternative feel risky, slow, unreimbursed, or legally exposed.
Recent research reported by Docwire News found that 41.6% of physicians reported high moral distress, compared with 14.2% of non-physician workers. Moral distress is linked to burnout, plans to leave practice, and intentions to reduce work hours. It produces guilt, shame, loss of meaning, and erosion of professional identity.
Academic literature in PubMed by Locke et al. describes moral injury in medicine as a consequence of being unable to provide the care physicians believe patients need within the constraints of the system.
Ironically, when physicians feel stressed, it may actually lower the threshold for delivering unnecessary treatment. When a physician is exhausted, overbooked, legally anxious, and emotionally drained, the hard conversation becomes harder. Ordering the test becomes easier.
Join the overtreatment conversation
Overtreatment is a systemic problem with deeply personal consequences. It harms patients through unnecessary procedures, avoidable side effects, anxiety, financial burden, and cascading workups. It harms you by forcing you to practice against your better judgment, leading to burnout, moral distress, and defensive medicine.
The solution requires system-wide reform: payment models that reward value, tort reform that reduces fear-driven ordering, better interoperability, stronger appropriateness criteria, and healthcare cultures that respect clinical restraint. But as an individual physician, you are not powerless. You can apply evidence-based guidelines, practice shared decision-making, document reasoning clearly, question financial incentives, train residents to value restraint, and talk openly with peers about the pressures that drive medical overuse.
Sermo gives you a place to discuss overtreating honestly. Join Sermo to connect with peers navigating the same pressures, share strategies for reducing unnecessary tests and procedures, and help shape a better standard for care that protects both patients and doctors.
