Anywhere from one-fifth to nearly one-third of the tests and treatments we get are estimated to be unnecessary, and avoidable care is costly in more ways than the bill: It may lead to dangerous side effects.
It can start during birth, as some of the nation's increasing C-sections are triggered by controversial fetal monitors that signal a baby is in trouble when really everything's fine.
It extends to often futile intensive care at the end of the life.
• Americans get the most medical radiation in the world, much of it from repeated CT scans. Too many scans increase the risk of cancer.
• Thousands who get stents for blocked heart arteries should have tried medication first.
• Doctors prescribe antibiotics tens of millions of times for viruses such as colds that the drugs can't help.
• As major health groups warn of the limitations of prostate cancer screening, even in middle age, one-third of men over 75 get routine PSA tests despite guidelines that say most are too old to benefit. Millions of women at low risk of cervical cancer get more frequent Pap smears than recommended; millions more have been screened even after losing the cervix to a hysterectomy.
• Back pain stands out as the No. 1 overtreated condition, from repeated MRI scans that can't pinpoint the trouble to spine surgery on people who could have gotten better without it. About one in five who gets that first back operation will wind up having another in the next decade.
Overtreatment means someone could have fared as well or better with a lesser test or therapy, or maybe even none at all. Avoiding it is less about knowing when to say no, than knowing when to say, "Wait, doc, I need more information!"
The Associated Press combed hundreds of pages of studies and quizzed dozens of specialists to examine the nation's most overused practices. Medical groups are starting to get the message. Efforts are under way to help doctors ratchet back avoidable care and help patients take an unbiased look at the pros and cons of different options before choosing one.
"This is not, I repeat not, rationing," said Dr. Steven Weinberger of the American College of Physicians, which this summer begins publishing recommendations on overused tests, starting with low back pain.
It's trying to strike a balance, to provide appropriate care rather than the most care. Rare are patients who recognize they've crossed that line.
"Yet let me tell you, with additional tests and procedures comes significant harm," said Dr. Bernard Rosof, who heads projects by the nonprofit National Quality Forum and an American Medical Association panel to identify and decrease overuse.
"It's patient education that's going to be extremely important if we're going to make this happen, so people begin to understand less is often better," he said.
Not even doctors' families are immune.
A hospital appropriately did six CT scans to check Dr. Steven Birnbaum's 22-year-old daughter for injury after she was hit by a car. But the next day, Molly had an abdominal scan repeated as a precaution despite having no symptoms. When a doctor ordered still another, "I blew a gasket," said the New Hampshire radiologist, who put a stop to more.