Context
- Modern medicine has achieved remarkable progress in early diagnosis, disease prevention and life-saving treatment.
- However, technological advances have also encouraged overtreatment and overmedication, exposing patients to unnecessary tests, procedures and prolonged medication.
- In India, this problem coexists with under-treatment, as many people still lack essential primary care, affordable medicines and timely treatment.
- The challenge is to ensure that medical interventions meet genuine patient needs rather than commercial interests or misplaced expectations.
Health Packages and Tests
- Unnecessary Testing and Overdiagnosis
- The expansion of diagnostic technology has increased testing without always improving clinical decisions.
- A 2016 review in the National Medical Journal of India found that routine health-check packages often include unnecessary tests, leading to false-positive results, anxiety, overdiagnosis and unnecessary treatment.
- Incidental abnormalities can trigger further investigations and interventions that offer limited benefits.
- Fragmentation of Health Care
- India's excessive reliance on specialist and super-specialist services can result in duplicated investigations, conflicting prescriptions and poor coordination.
- Patients with chronic conditions may consult several specialists who treat individual diseases without considering overall health.
- Integrated and coordinated care is essential to prevent unnecessary interventions.
- Polypharmacy Among Older Adults
- Polypharmacy refers to the use of multiple medicines, commonly five or more simultaneously.
- A 2021 review reported polypharmacy in approximately 49% of older adults in the Indian studies examined.
- A 2025 study found that roughly one-third of older adults took five or more prescribed medicines, with potentially inappropriate medicines identified in 28.8% of cases.
- Although multiple medicines may be necessary, inappropriate prescribing increases the risks of adverse reactions and drug interactions.
- Regular medication reviews and deprescribing can help discontinue unnecessary medicines safely.
- Commercialisation of Health Care
- India's fee-for-service model may encourage additional tests and procedures because providers earn revenue from the services delivered.
- Patients may also expect prescriptions or investigations after every consultation.
- Health insurance offers financial protection but can encourage unnecessary expenditure when patients or providers favour costly interventions because another party bears the immediate financial burden.
- Such moral hazard can increase waste, although patients continue to bear the physical risks.
- Patient Expectations and Defensive Medicine
- Patients often associate scans and medicines with effective treatment, while reassurance and lifestyle advice may appear inadequate.
- Doctors working under time pressure may respond to these expectations.
- Defensive medicine also encourages unnecessary testing when clinicians fear missing rare diagnoses or facing legal consequences.
- However, tests can produce false-positive results, anxiety and further unnecessary procedures.
Choosing Wisely Movement
- The international Choosing Wisely movement promotes informed decisions about medical tests and treatments.
- Between 2012 and 2023, nearly 80 specialty societies worldwide published close to 700 recommendations identifying interventions that clinicians and patients should question.
- The movement emphasises that good medicine requires appropriate treatment rather than simply more treatment.
- Addressing overmedicalisation requires cooperation among patients, doctors, professional organisations, hospitals, insurers and policymakers.
Objectives of Choosing Wisely Movement
- Strengthen Primary Care and Family Medicine
- India must strengthen accessible and affordable primary health care and restore the family physician as the first point of contact for non-emergency needs.
- General physicians can coordinate treatment, reconcile prescriptions and refer patients to specialists when necessary, reducing duplicate investigations and excessive medication.
- Make Prescription Reviews Routine
- Every prescription should include a review date and, where appropriate, a stop date.
- Older adults and patients taking five or more medicines should undergo structured reviews assessing effectiveness, interactions, duplication and opportunities for safe deprescribing.
The Path Forward for India
- Identify Low-Value Medical Interventions
- The Indian Council of Medical Research (ICMR) and professional medical societies should develop India-specific lists of low-value tests, treatments and procedures.
- These recommendations should be integrated into medical education, accreditation and hospital quality-improvement programmes.
- Hospitals should assess not only whether necessary treatment was provided but also whether unnecessary interventions were avoided.
- Empower Patients Through Informed Decisions
- Patients should participate actively in medical decisions by asking four questions:
- Why do I need this test or treatment?
- What happens if I wait?
- What are its benefits and risks?
- What alternatives are available?
- Shared decision-making improves communication and helps patients make informed choices.
- Reform Payment and Insurance Systems
- Payment systems and insurance policies should reward clinical outcomes, continuity of care and appropriate treatment, rather than the volume of services provided.
- Financial incentives should encourage preventive care and thoughtful clinical judgement.
Conclusion
- Medical progress must improve health outcomes without exposing patients to avoidable harm.
- India needs stronger primary care, evidence-based guidelines, regular medication reviews and informed patients to balance undertreatment with overtreatment.
- Ultimately, good medicine requires action when it helps and restraint when it does not.
- Recognising when not to test, prescribe or operate is essential to building a safer, more affordable and equitable health-care system.
