GP LAND

Overdiagnosis, “too much medicine” and low-value care in general practice

May 26, 2026 / No Comments

Core concept

Overdiagnosis occurs when a person is diagnosed with a disease or abnormality that would never have caused symptoms, morbidity or death during their lifetime, but the diagnosis exposes them to potential harm from labelling, anxiety, surveillance, further testing or treatment. It is not simply “finding disease early”; it is finding disease where the net effect of diagnosis is more harm than benefit. [BMJ Evidence-Based Medicine: Overdiagnosis—what it is and what it isn’t]

The RACGP frames this within “too much medicine”, meaning excessive or unnecessary use of tests, medicines and procedures that can harm patients and waste health resources. [RACGP: Too much medicine]

1. Key definitions

Overdiagnosis

Overdiagnosis means making people patients unnecessarily by:

  • identifying abnormalities that would not have caused harm; or
  • medicalising ordinary life experiences through expanded disease definitions.

Example: detecting an indolent thyroid cancer that would never have caused symptoms, while mortality remains unchanged despite rising incidence.

Overdetection

Overdetection is the detection of abnormalities that:

  • do not progress;
  • progress too slowly to cause harm;
  • resolve spontaneously; or
  • would never become clinically relevant in the patient’s lifetime.

Common sources:

  • high-resolution imaging;
  • screening;
  • incidental findings;
  • direct-to-consumer testing;
  • self-testing technologies.

Example: small subsegmental pulmonary emboli found on highly sensitive CT pulmonary angiography, where clinical significance may be uncertain.

Overdefinition / diagnosis creep

Overdefinition occurs when disease thresholds are lowered or definitions widened, so people with mild symptoms or low risk are newly labelled as diseased without clear evidence of net benefit.

Examples:

  • lowering blood pressure thresholds;
  • expanding “pre-disease” categories;
  • labelling risk factors as diseases;
  • broadening psychiatric diagnoses to include milder or transient symptoms.

Australian Prescriber describes this as diagnosis creep, where broadened definitions increase the number of people classified as diseased. [Australian Prescriber: Caution! Diagnosis creep]

Overtesting

Overtesting means ordering tests where the likely benefit is low or where the result is unlikely to change management. Overtesting can increase overdiagnosis but is not identical to overdiagnosis.

Overtreatment

Overtreatment occurs when treatment provides little or no benefit for the patient’s condition, or when harms outweigh benefits. It may follow overdiagnosis, but it can also occur after a correct diagnosis.

Example: antibiotics for acute bronchitis, where the diagnosis may be correct but antibiotics are usually ineffective.

False positive

A false positive is an abnormal test result that later proves not to represent disease. This is different from overdiagnosis, where the abnormality meets disease criteria but would not have caused harm.

Misdiagnosis

Misdiagnosis is an incorrect diagnosis. Overdiagnosis is different: the diagnosis may be technically correct according to current criteria, but clinically unnecessary or harmful.

2. Why overdiagnosis matters in general practice

General practice is especially exposed to overdiagnosis because GPs manage:

  • screening requests;
  • incidental imaging/pathology findings;
  • mildly abnormal biomarkers;
  • patient anxiety from online health information;
  • commercial health checks;
  • follow-up of specialist-initiated investigations;
  • chronic disease labels and risk-factor management.

3. Mechanisms of overdiagnosis

A. Lowering diagnostic thresholds

Small changes in disease thresholds can label large numbers of people as having disease.

Examples including hypertension and diabetes thresholds, where lowering thresholds increases disease prevalence and exposes lower-risk patients to treatment with smaller absolute benefit.

Clinical issue:

  • patients at lower baseline risk have lower absolute treatment benefit;
  • medication adverse effects may outweigh benefit;
  • labelling can cause anxiety and alter self-perception.

B. Labelling risk factors as diseases

Risk factors are increasingly framed as diseases, for example:

  • hypertension;
  • hyperlipidaemia;
  • chronic kidney disease;
  • osteoporosis;
  • obesity;
  • fatty liver disease;
  • prediabetes.

This can be useful when it guides prevention, but harmful when the label creates anxiety or treatment burden without meaningful outcome benefit.

C. Screening

Screening can be valuable when it clearly reduces morbidity or mortality, but not all screening is beneficial.

Useful screening requires:

  • important health problem;
  • reliable test;
  • effective early treatment;
  • evidence that screening improves patient-centred outcomes;
  • acceptable balance of benefits and harms;
  • clear target population and interval.

Choosing Wisely Australia promotes questioning tests and procedures that are not evidence-based, duplicative, free from harm, or truly necessary. [Choosing Wisely Australia / RACGP]

D. Incidentalomas

Incidentalomas are unexpected findings unrelated to the original reason for testing. They can trigger cascades of:

  • repeat imaging;
  • invasive procedures;
  • specialist referral;
  • patient anxiety;
  • surveillance for uncertain abnormalities.

Glasziou and Doust note that approximately a quarter of CT pulmonary angiograms may detect unexpected findings such as pulmonary nodules, thyroid nodules or adenopathy.

E. Increased sensitivity of tests

More sensitive tests detect smaller or earlier abnormalities. This may improve outcomes in some settings, but can also detect disease that is biologically indolent.

Example:

  • CT pulmonary angiography increased pulmonary embolism diagnosis but mortality changed little, suggesting some detected emboli may not have been clinically significant.

F. Medicalisation of ordinary life

Some normal human experiences may be reframed as diseases, particularly when symptoms are mild, transient or context-dependent.

Examples:

  • sadness labelled as depression;
  • shyness labelled as anxiety disorder;
  • grief medicalised;
  • poor concentration labelled as ADHD;
  • normal ageing reframed as deficiency or disease.

This does not mean these conditions are not real. The key issue is where the threshold is drawn and whether diagnosis improves outcomes for that patient.

4. Harms of overdiagnosis and too much medicine

Patient-level harms

Overdiagnosis can cause:

  • anxiety and distress;
  • disease labelling;
  • unnecessary surveillance;
  • invasive procedures;
  • adverse drug reactions;
  • over-treatment;
  • radiation exposure from repeated imaging;
  • financial costs;
  • insurance implications;
  • reduced quality of life.

Community-level harms

At population level, too much medicine can:

  • divert resources from patients with serious disease;
  • increase waiting times;
  • reduce health system sustainability;
  • worsen inequity;
  • increase antimicrobial resistance through unnecessary prescribing.

The RACGP specifically supports “optimal medicine”, where the benefits and harms of tests and treatments are carefully weighed to prevent injury and wastage. [RACGP: Too much medicine]

5. What overdiagnosis is not

Not the same as false positive

A false positive is an abnormal result that turns out not to be disease. Overdiagnosis is real disease by current definitions, but disease that would not have caused harm.

Not the same as misdiagnosis

Misdiagnosis is a wrong diagnosis. Overdiagnosis may be pathologically or technically correct, but clinically unhelpful.

Not the same as overtreatment

Overdiagnosis often leads to overtreatment, but overtreatment can also occur after correct diagnosis.

Not the same as overtesting

Overtesting increases the risk of overdiagnosis, but a test can be unnecessary without causing overdiagnosis.

6. Practical GP approach

A. Before ordering a test, ask

  • What diagnosis am I considering?
  • How likely is serious disease?
  • Will the result change management?
  • What are the possible false positive or incidental findings?
  • What downstream tests might follow?
  • Could watchful waiting be safer?
  • Is this test recommended for this patient’s risk group?
  • Has the patient already had the test elsewhere?

B. Use evidence-based screening, not opportunistic over-screening

Use RACGP Red Book-style preventive care principles:

  • screen according to age, sex and risk category;
  • avoid non-recommended screening tests;
  • avoid commercial “whole-body checks” or broad panels without indication;
  • discuss absolute benefit and harm, not just relative risk.

The RACGP notes that the Red Book provides preventive test-ordering recommendations stratified by risk category and based on current evidence. [RACGP: Too much medicine]

C. Use watchful waiting where appropriate

Watchful waiting is suitable when:

  • symptoms are mild;
  • serious pathology is unlikely;
  • natural history is usually self-limiting;
  • test results are unlikely to change management;
  • there is a clear safety-net plan.

Examples in GP:

  • mild viral respiratory symptoms;
  • non-specific low back pain without red flags;
  • minor abnormal pathology likely to normalise;
  • mild self-limiting gastrointestinal illness;
  • uncomplicated viral bronchitis.

D. Use delayed prescribing where appropriate

Delayed prescribing can reduce unnecessary antibiotic use when bacterial infection is uncertain and the patient is stable.

Approach:

  • explain likely natural history;
  • provide criteria for starting treatment;
  • provide red flags;
  • arrange review if worsening.

E. Deprescribing and medication review

Overdiagnosis contributes to polypharmacy. Medication review should consider:

  • current indication;
  • ongoing benefit;
  • adverse effects;
  • patient goals;
  • frailty;
  • life expectancy;
  • treatment burden;
  • cumulative anticholinergic/sedative burden.

7. Communication with patients

Key explanation

“Some tests can find abnormalities that look concerning but would never have caused you harm. The problem is that once we find them, they can lead to more scans, biopsies, treatment, anxiety and cost. So the safest care is not always doing more tests — it is doing the right tests for your risk and symptoms.”

Shared decision-making points

Discuss:

  • expected benefit;
  • possible harms;
  • uncertainty;
  • alternative options;
  • watchful waiting;
  • patient values;
  • safety-netting.

Useful phrasing

Instead of saying:

  • “You have hypertension”
    Consider: “Your blood pressure is raised today; we need to confirm whether this is persistent and assess your overall cardiovascular risk.”

Instead of:

  • “You have cancer” for very low-risk lesions where terminology is debated
    Consider: “This is a low-risk lesion/abnormality, and the key question is whether treatment or monitoring is safer.”

The RACGP encourages precise diagnostic language, including terms such as “lesion” rather than “cancer” where appropriate, and “raised blood pressure” rather than immediately labelling “hypertension”.

8. Examples relevant to GP

Imaging

Avoid imaging for uncomplicated acute low back pain without red flags, because incidental disc degeneration is common and may lead to unnecessary interventions.

Antibiotics

Avoid antibiotics for likely viral bronchitis or URTI, because treatment benefit is low and harms include adverse effects and antimicrobial resistance.

Screening

Use evidence-based screening programs rather than broad “screen everything” testing.

Incidental pathology

Mildly abnormal results should be interpreted in clinical context. Repeating the test after an appropriate interval may be safer than immediate extensive workup.

Cardiovascular risk

Treat the patient’s absolute cardiovascular risk, not single numbers in isolation, where guidelines support risk-based decision-making.

9. Causes and drivers

Commercial drivers

The RACGP identifies commercial interests as a contributor to too much medicine, including pharmaceutical companies, medical technology companies, wellness clinics and commercial screening services.

Technology

More sensitive imaging and pathology tests detect more abnormalities, but not all detected abnormalities are clinically important.

Disease definition panels

Widening definitions or creating pre-disease states can increase diagnoses. The RACGP notes concerns about conflicts of interest and lack of international standards for panels that define disease thresholds.

Patient expectations

Patients may believe that:

  • more testing is safer;
  • early detection is always beneficial;
  • normal results are needed for reassurance;
  • abnormal results always require action.

GP role: validate concern, then explain benefit–harm balance.

Clinician behaviour

Drivers include:

  • fear of missing serious disease;
  • fear of complaints or litigation;
  • time pressure;
  • billing structures;
  • habit;
  • over-reliance on technology;
  • under-use of watchful waiting.

11. Practical framework: “TEST” before testing

T — Target

What condition am I testing for?

E — Effect

Will the result change management?

S — Safety

What harms could follow from the test?

T — Timing

Is testing needed now, or is review/watchful waiting safer?

12. Take-home summary

  • Overdiagnosis is diagnosis that does not improve outcomes and may cause harm.
  • It occurs through overdetection and overdefinition.
  • It is different from false positives, misdiagnosis, overtesting and overtreatment.
  • GPs are central to preventing too much medicine because they manage screening, early symptoms, incidental findings and long-term labels.
  • More testing is not always safer.
  • The safest approach is evidence-based, patient-centred, risk-stratified care with shared decision-making and clear safety-netting.

References

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