Modern medicine has never been more capable than it is today. Tests detect illness earlier, scans reveal invisible abnormalities, medicines prevent and treat diseases, and interventions and procedures can save lives within minutes. Yet, the same system that can do more is increasingly tempted to overtreat and overmedicate.
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Overtreatment and overmedication are not simply the use of an unnecessary medicine but often a chain: a test detects an incidental abnormality, which leads to another test, a diagnosis and then a prescription that may become permanent. What begins as prevention can end in long-term medication or surgery. Then, in India, overtreatment coexists with undertreatment: unnecessary interventions are offered to some, while many others still lack essential primary care, affordable medicines and timely treatment.
Health packages and tests
The rise of overtreatment is the result of a convergence of several factors. The first driver of overtreatment is unnecessary and excessive testing — both screening and diagnostic — which creates a cascade of care. A review article in the prestigious National Medical Journal of India in 2016 found that routine health-check packages often include unwarranted tests that can lead to false-positive results, anxiety, further investigations, overdiagnosis and overtreatment. The truth is that the ability to test has expanded faster than our ability to decide who actually needs testing.
The second driver is the fragmentation of health and medical care. Its most visible manifestation in India is an excessive focus on specialist and super specialist care. A person with a common health problem often goes directly to a specialist or superspecialist. A person with chronic conditions may consult several specialists, each optimising one part of care without necessarily paying attention to the person’s other health problems. The patient is treated in parts, while the human body does not live in specialties.
This matters particularly in older adults. A systematic review and meta-analysis of Indian studies, published in Frontiers in Pharmacology in 2021, reported polypharmacy in about 49% of older adults. Another study, published in Scientific Reports in 2025, found that roughly one-third of older adults were taking five or more prescribed medicines (polypharmacy), with potentially inappropriate medicines identified in 28.8% of cases.
These figures do not mean that everyone taking several medicines is being overtreated. They do, however, show why medication reviews and deprescribing must become routine.
A third force is the transformation of health care into a marketplace. Laboratory tests, radiological investigations, procedures, supplements and monitoring devices have become products to be sold — sometimes products in search of potential customers. As a result, the boundaries between those who genuinely need these interventions and those who do not can become blurred. A linked aspect is that much of health care and medical care in India operates on a fee-for-service model, which can reward activity rather than restraint. Many patients consider a medical consultation complete only when several medicines and investigations have been prescribed.
Health insurance is a proven solution for financial protection from health-related expenses, as the cost is borne by the insurer. However, it can create both ‘ex-ante’ and ‘ex-post’ moral hazards, discouraging preventive care and encouraging hospitals and patients to favour costlier interventions. What is forgotten is that while someone else may bear the financial cost, it is the patient’s body that undergoes the intervention. Paying insurance premiums for years does not mean that one must ‘recover’ the money by undergoing a relatively unnecessary procedure or surgery.
Fourth, patient beliefs and expectations arising from advances in medical care where people want certainty when they are worried and may feel that something tangible should follow a consultation. Reassurance can look like inaction; observation can feel inferior to a scan; lifestyle advice can appear less serious than medication. Doctors may respond to these expectations, particularly in crowded clinics where explanation requires time.
The fifth driver is the rise of ‘defensive medicine’, in which clinicians, fearing that they might miss a rare diagnosis, may consider ordering another test as the safer option. What is often forgotten, however, is that every test carries potential risks, both from the test itself and from the discovery of abnormalities that may never have caused harm.
Choosing wisely
India is not alone in facing this problem. Overtreatment first became widely recognised in high-income countries and is now increasingly visible across many middle-income nations. This gave rise to the global Choosing Wisely movement, which encourages people to choose health-care interventions more carefully. It is against this backdrop, between 2012 and 2023, that nearly 80 specialty societies worldwide published close to 700 recommendations identifying hundreds of tests and treatments that clinicians and patients should question. The message is that medicine requires stronger mechanisms for self-correction. The solutions are about practising better medicine. Halting and reversing overmedicalisation requires the engagement of all stakeholders, including individuals, communities, professional societies and health policymakers.
First, India needs to rebuild stronger and functional primary care and restore the family physician as the first point of contact for most non-emergency health needs. A general physician can decide which problems require specialist expertise, reconcile multiple prescriptions and recognise when treatment can safely be reduced. Initiation of care by a general physician, followed by continuity through the referral pathway, protects patients against overmedication and excess surgeries.
Second, every medical prescription should carry a review date and, where appropriate, a possible stop date. Medicines should not become lifelong simply because nobody asks whether they are still needed. Older adults and people taking five or more medicines should periodically undergo a structured medication review assessing indication, benefit, duplication, interactions and opportunities for deprescribing.
Develop India-specific lists
Third, professional medical societies and the Indian Council of Medical Research should develop Indian lists of low-value tests, treatments and procedures — similar to Choosing Wisely — and embed these principles in medical training, accreditation and quality-improvement programmes. Hospitals should measure not only whether recommended care was provided, but also whether unnecessary care was avoided.
Fourth, before starting any test or treatment, patients should note that these four questions matter: Why do I need this? What happens if I wait? What are the possible benefits and risks? What are the alternatives? These questions can substantially improve clinical conversations and outcomes.
Fifth, payment systems and health insurance must reward outcomes, clinical reasoning and continuity of care rather than volume alone. A health-care system should not make it financially easier to order a scan than to explain thoughtfully why that scan may be unnecessary.
Medical advances will continue — and they should. However, the next stage of medical progress will come not only from discovering more tests, medicines and procedures, but also from learning when not to use them. Good medicine requires action when action helps. In an age of medical abundance, it increasingly requires something more difficult — restraint.
Dr. Chandrakant Lahariya is a practising physician and the author of ‘Pill-Free: You Don’t Need Everything You Have Been Prescribed’ (2026)