Too much medicine happens too often: the teachable moment and a call for manuscripts from clinical trainees.

A columnist at theNew York Times asked readers, “Have you experiencedtoomuchmedicine?”Shereceivedmorethan1000 responses detailing examples ranging fromunnecessary testing and hospitalizations to useless office visits and specialist referrals.1 Patients are not the only ones worried about too muchmedicine: 42%of anational sampleofprimary carephysicians believe that patients in their own practice are receiving too muchmedical care.2 Too much medicine, or overuse, occurs in at least 3 contexts: when benefits from medical care are negligible, when thepotential for harmexceeds thepotential benefit,3 orwhen a fully informed patient would decide to forego the service. Examples of overuse include overtesting (eg, routinely ordering preoperative chest x-rays; see the Perspective in this issue4) and overtreatment (eg, coronary revascularization inpatientswith stable anginanot receivingoptimalmedical therapy). Spending on overuse is thought to substantially contribute to theunsustainablegrowth inUShealthcarecosts.5 Wastefulhealthcare is estimated tocost $750billionannually,6 limiting equitable access tonecessaryhealth care6 andcrowdingout spendingonotherpriorities suchaspublichealth, education, and valuable social programs.When passed on to our patients, health care costs can be financially catastrophic.7 The costs of overuse are not measured in dollars alone. Overtesting and overtreatment expose patients to potential harmsanddownstreamcomplications8—andoften lead tonet harm.Farbeyondcostconsciousness, theethicalcase foravoiding overuse, “first, do no harm,” is a powerful appeal to our professionalism.8 All thoughtful physicians want to minimize harms fromoveruse. The challenge is recognizingwhen an intervention is likely to represent overuse.