Why Patients Demand Unnecessary Treatments

by Jon Scaccia January 24, 2025

Healthcare systems worldwide grapple with the costly and detrimental phenomenon of low-value care—medical interventions that provide little to no benefit, may cause harm, and contribute to the inefficiency of healthcare systems. Alarmingly, low-value care accounts for an estimated 20% of healthcare spending in the U.S. and a similar proportion in other high-income countries. Examples include routine imaging for non-specific back pain, unnecessary prescriptions of antibiotics, or overuse of PSA testing in older men.

But why do patients demand such interventions? A recent scoping review sheds light on this complex issue, identifying a range of psychological, cultural, and systemic factors that fuel patient demand for low-value care.

The Hidden Forces Driving Demand

The study, which analyzed 47 articles, categorized patient-driven factors into eight core themes and 33 subthemes. These themes offer a nuanced understanding of why patients request care that may not serve their best interests.

1. Cognitive Biases

Human decision-making is far from rational, often shaped by cognitive biases—automatic, unconscious thought patterns. For example:

• Risk Aversion and Anticipated Regret: Patients might request tests or treatments “just in case,” driven by a fear of overlooking a potential illness or regret if a missed condition worsens.
• Extension Bias: The pervasive belief that “more care is better care” leads some patients to seek excessive interventions, even when less invasive options would suffice.
• Imperative Knowledge Bias: Patients often overvalue diagnostic information, subscribing to the notion that “knowing is always better than not knowing,” even when the knowledge has no actionable benefit.

2. Emotions and Anxiety

Fear and insecurity often dominate healthcare decisions. For instance, a patient worried about a possible cancer diagnosis might push for extensive testing to alleviate their anxiety, regardless of medical advice. This “peace of mind” can drive demand for screenings or procedures that may ultimately lead to overdiagnosis and overtreatment.

3. Social and Cultural Pressures

Patients’ demands don’t arise in a vacuum. Cultural norms and social networks play a significant role:

• Family Influence: Relatives may pressure patients to seek certain treatments, either out of concern or a belief that more care equals better outcomes.
• Entitlement to Care: Some patients, particularly in countries with universal healthcare, perceive access to all care as a right, regardless of necessity.

4. Economic Considerations

The economics of healthcare also influence demand. Patients with comprehensive insurance coverage may feel less financial risk in pursuing low-value care, while those worried about missed work or income loss may request quick fixes to maintain productivity.

Bridging the Gap Between Perception and Evidence

While these factors help explain patient behavior, they also highlight the challenge for healthcare providers and policymakers. Patients often view healthcare through a personal lens, shaped by emotion, cultural values, and incomplete information. Bridging the gap between patient perception and evidence-based care requires targeted interventions.

Shifting Mindsets Through Communication

One of the most promising strategies involves improving patient-provider communication. Clinicians can use insights from this review to:

• Address patient concerns about risk and regret by offering clear, evidence-based explanations.
• Gently challenge misconceptions like “more is better” by discussing the potential harms of overtesting and overtreatment.
• Foster trust by engaging in shared decision-making, where patients feel heard but also guided toward high-value care options.

Public Health Campaigns and Education

On a broader scale, public health campaigns can play a vital role in addressing the cultural and emotional drivers of low-value care. Messaging should:

• Highlight the potential harms of overdiagnosis and overtreatment.
• Empower patients to ask informed questions and prioritize evidence-based interventions.
• Counter misleading marketing by pharmaceutical or diagnostic companies that promote unnecessary care.

A Systemic Problem Requires a Systemic Solution

Low-value care is not merely a patient problem; it’s a systemic one. Providers often face pressure to satisfy patient demands, avoid malpractice claims, or meet productivity targets. Meanwhile, healthcare systems incentivize procedures over prevention. Addressing patient demand is only one piece of a larger puzzle that requires reform across supply-side factors, financial models, and cultural attitudes toward healthcare.

What’s Next?

While this study offers a comprehensive overview of patient-driven factors, it also underscores the need for further research. Key questions include:

• How do these factors interact with supply-side and systemic drivers to perpetuate low-value care?
• What interventions are most effective in reducing demand without leading to underuse of high-value care?
• How do cultural differences shape patient demand in various healthcare systems worldwide?

As healthcare systems aim to balance cost containment with high-quality care, reducing low-value interventions is essential. This research provides a roadmap for clinicians, policymakers, and public health practitioners to better understand and address the root causes of unnecessary care.

Join the Conversation

What strategies have you seen work in reducing low-value care in your practice or community? How can public health messaging effectively address the emotional and cultural drivers of patient demand? Share your thoughts, experiences, and ideas in the comments or on social media. Together, we can work toward a healthcare system that prioritizes value and quality for all.

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