Healthcare is progressively used to provide reassurance, rather than to heal. Even without clinical necessities, parents increasingly tend to request medical tests for their children. Also for adults and elderly patients, more and more screening possibilities for medical conditions are offered (1). In the Netherlands, besides the existing national screening programs for breast cancer, cervical cancer, and colon cancer, early screenings for Alzheimer’s disease and prostate cancer are in their experimental phase (2). The global rise in chronic condition diagnoses, however, raises concerns that expanding diagnostic criteria may be medicalising normal health variations, turning more people into patients without clear benefits. These patterns aren’t unique to the Netherlands. In the UK, for example, research shows that breast cancer screenings can lead to overdiagnosis and unnecessary treatment (3) (4).

Against this backdrop, the recent decision by the Dutch National Health Care Institution to remove PARP inhibitors, a type of cancer drug that targets specific genetic mutations, from the basic insurance package marked a rare moment of boundary-setting (5). The institute calls for more carefully considered choices in the medical care that physicians should provide.

It raises pressing questions: How did the pursuit of certainty become such a dominant force in medicine? When does treatment serve the patient, and when does it serve our need to feel in control of risks? And if overtreatment threatens the sustainability of our system, how can we redefine what it means to provide good care?

Certainty as medical expectation

In recent years, there has been a growing discomfort with uncertainty in our Western societies. We prefer to be safe rather than sorry (6). It is no coincidence that the market for extended warranties on electronics has seen steady growth (7). This societal thread has now also spread to our healthcare systems. Our illusion of malleability, together with growing medicalization and decreased risk tolerance, causes an urge for overtreatment (8). General Practitioner Bart Meijman explains that “We believe humans can solve everything”. This makes it hard for us to accept when something is out of our control (9). Besides that, death itself has also become something that we fear (10).

As a result, we’ve allowed overdiagnosis as a driver to alleviate fear (11) (12). The Dutch Council for Public Health and Society (Raad voor Volksgezondheid en Samenleving (RVS)) has labeled this phenomenon as ‘diagnostic-expansion’: a rise across all age groups of medical labels and excessive diagnostics expressed in early screenings and unnecessary medical testing (13) (14). Fabienne Ropers, a general pediatrician, explains that people (most frequently parents), to a growing extent, interpret normal symptoms as signs of medical issues that they want to eliminate. This tendency means that mild complaints frequently generate uncertainty and concern within parents about their children’s health. As a result, parents more often insist on medical tests for their children, even when there is no clear medical necessity (15).

Medicine as a reassuring illusion

Our growing discomfort with medical uncertainty has led to growing pressure on our healthcare system. It leads to more check-ups, scans, and prescriptions for expensive medications that do not always have proven effectiveness. As a result, we are seeing a rise in what is called ‘almost patients’ (16). ‘Almost patients’ are people diagnosed with conditions that would never have caused symptoms or harm if they had gone undetected. This phenomenon is called ‘overdiagnosis’: a person is treated, operated on, or given medication for a condition that would not have impacted their quality of life (17).

In breast cancer screening alone, estimates suggest that 10% to 30% of diagnoses fall into this category (18). While early detection can be life-saving, mass screenings can also produce false positives and ambiguous results, triggering unnecessary stress and interventions for people with no actual complaints. These tests often detect harmless abnormalities or uncover conditions no one was even looking for (19). The treatments that follow may ease fear, but don’t always improve outcomes. They can bring additional stress and side effects like fatigue, inflammation, or long-term complications (20).

An example can be found in the screening for prostate cancer. One-third of men over 60 are found to have it after death, without ever having experienced symptoms. Screening this group increases diagnoses, but also subjects men to stress and serious treatment complications, often with little to no benefit (21) (22). Regardless of the consequences of treatment, across all age groups, we choose short term control to prevent any risk.

However, it is not only the patients which play a role in this over diagnosis. Many doctors strive to know everything, miss nothing, and avoid any risk of ending up before the disciplinary board for something they could have prevented (23). This last issue has made many feel legally vulnerable, particularly when deviating from guidelines that opt for limited treatment. Additionally, saying ‘no’ for doctors has simply become harder. In the consultation room, long-term concerns like sustainable healthcare fade into the background. Faced with a worried patient, doctors often feel compelled to agree to tests, even when they know it's not medically necessary (24).

The price of overtreatment

Healthcare costs have been rising for years. Not just because people live longer or survive diseases that were once be fatal, but increasingly due to our need for preventive medicine (25). The growing demand for treatment puts pressure on our healthcare budget. Spendings on expensive drugs for cancer and other diseases alone have “nearly increased tenfold over the past ten years to three billion euros per year”, oncologist Gabe Sonke points out (26). As costs are rising, difficult decisions must be made, like the recent choice by the Dutch National HealthCare Institution to stop reimbursing PARP inhibitors (27). Turning people unnecessarily into patients strains the health system, ultimately at the expense of those with real medical needs.

When insurance premiums rise or treatments are no longer covered, it is often patients with fewer financial resources who suffer the most. The problem is that these tests place an unnecessary financial burden on society since you are not paying for your own test, but society as a whole is. This makes examinations without medical necessity financially unsustainable (28) (29).

Meanwhile, the ones that benefit are pharmaceutical companies and hospitals, who see their revenues rise with every new patient (30) (31). Overdiagnosis is not only the product of societal risk-aversion, but also of a profit-driven pharmaceutical model (32). A striking example is Humira, a drug sold for years at a sky-high price in the Netherlands, earning billions for its producer AbbVie. The profits were so large that they have recently sparked groundbreaking legal rulings questioning the fairness of pharmaceutical pricing and its impact on public health budgets (33).

Redefining good care

So, how can we reduce overtreatment and keep the basic health insurance package financially sustainable (34)?

Some advocate for an entirely new financing model: reimbursing only those treatments that have proven effective afterwards. The risk in that, however, is that complex patients may be excluded, as they are seen as a financial liability (35). Others suggest we should shift our focus from testing to preventing illness, for instance through introducing legal or policy measures such as sugar taxes, smoking bans in public spaces, or regulations on urban planning that promote physical activity (36).

Beyond new funding systems or policies, a more fundamental shift might lie in the willingness to accept that less can be more when it comes to good care. This means empowering doctors to rediscover the courage to say ‘no’ (37). Perhaps the organizational and educational environments should support this by offering assertiveness training and institutional backing, empowering doctors to act in line with their professional judgement. This also requires that we view doctors as the experts they are, whose judgment we can trust, rather than second-guessing them with search engines and second opinions (38). But as patients, we too can shift our approach. We should create space for reflection and critical thinking: do we really want every possible treatment, simply to eliminate even the faintest perceived risk? And can we gently encourage ourselves, and those around us, to reconsider whether that non-urgent check-up or test is truly necessary?

A growing movement aiming for this among healthcare professionals is known as Dappere Dokters. They advocate for a system that is grounded in medical knowledge and open dialogue, to improve health rather than simply offering reassurance (39). According to them, tough decisions are necessary to keep healthcare sustainable (40).

In 2018, Dutch member of parliament, Corinne Ellemeet (GroenLinks), helped break the political taboo around overtreatment by advocating for more honest discussions about the real benefits of invasive treatments for elderly patients. Today, hospitals such as LUMC and Haga screen patients over 70 for frailty before deciding on major treatments, placing patient well-being above routine intervention (41). In the UK, between the varying number of 10%-30% of women overdiagnosed through breast cancer screening have undergone surgery, radiation, or chemotherapy for tumors that might never have caused harm, but through these measures have caused psychological and physical distress (42).

We must normalize having these kinds of conversations (43). Ultimately, sustainable care starts with the courage to choose wisely and say ‘no’, accepting that in good healthcare, less can be more. Shall we?

This article is part of The Outside World, ftrprf’s very own research center.

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