Prevalence of Medical Overtesting – Advanced Health Academy

Medical testing plays a crucial role in diagnosis and patient management, from routine tests to more advanced investigations. However, the phenomenon of overtesting—defined as ordering unnecessary medical tests—is a significant and growing concern. Overtesting includes the use of non-recommended screening tests for asymptomatic patients or conducting more tests than needed for diagnostic clarity in symptomatic patients.

The Scope of Overtesting

How big is the problem? Studies reveal that up to 1/3 of all laboratory tests are unnecessary¹. This unnecessary testing not only inflates healthcare costs but can also expose patients to harm, including misdiagnoses, anxiety, and further unnecessary testing and treatment. Furthermore, the use of finite healthcare resources prevents their redeployment to others who would have benefited from tests, treatments and other interventions. These unintended consequences increase proportionately with the degree of overtesting.

For example, 69% of physicians believe unnecessary tests are ordered at least once a week² , while 91% of physicians admit to practicing defensive medicine, a practice where extra tests are ordered to avoid malpractice lawsuits³ . Another study highlighted that 31.4% of patient encounters resulted in diagnostic tests, despite 8.3% of physicians being uncertain about how to interpret the results⁴.

The financial impact is staggering. Up to 30% of all medical procedures are deemed unnecessary⁵, leading to billions of dollars wasted annually . According to a report from BMJ Open Quality, unnecessary tests burden the healthcare system with direct costs, and the resulting false positives and negatives can lead to further complications⁶. Over 85% of Emergency Physicians believed patients in their own Emergency Departments received too many diagnostic tests (e.g., blood tests, urine tests, imaging) as seen below¹¹.

Causes of Overtesting

Several factors drive this trend, including:

Defensive medicine – Physicians order tests to avoid legal repercussions.
Patient demands – Patients often request tests due to concerns about their health or expectations about what their care should include. A fear of a procedure cancellation can also lead to overtesting requests.
Diagnostic uncertainty – Physicians may lack confidence or clarity in interpreting symptoms or tests.
Profit incentives – Financial motivations and institutional policies encourage overtesting⁸. The odds of ordering common laboratory tests are up to 8 times higher among physicians with financial stakes in an on-site laboratory, even after adjusting for patient and practice differences¹⁰.
Experiential bias – Cognitive biases are associated with the impact of previous experience of clinical events. The fear of missing a diagnosis can lead providers to overtest, especially in low-probability conditions.
Recency bias – Physicians with recent negative clinical experiences are more likely to adopt an aggressive approach to diagnostic testing.
Reinforcement bias – Positive experiences from ordering labs can increase the likelihood of ordering further tests in the future.
Pressure from other Clinicians – One study found that as many as 89.6% of physicians would order a screening test they would not have otherwise ordered if specialists had recommended the test⁹.
Guidelines, protocols and policies – These all have a significant influence over test ordering behavior.

Surveys show that 97% of emergency physicians admitted to ordering unnecessary imaging tests due to fear of malpractice, even when they felt the tests were unnecessary⁷ .

The Consequences

Unnecessary testing doesn’t just waste time and money; it can also cause harm:

False positives lead to needless follow-up testing, treatment, and negatively affects patients physically, psychologically, and financially.
False negatives may delay proper treatment or create a false sense of security.
Overdiagnosis labels patients with “diseases” for conditions that would not have caused them harm if left undetected and untreated..

Strategies to Reduce Overtesting

To combat overtesting, healthcare systems and clinicians should:

Avoid baseline or screening tests unless medically justified.
Refrain from ordering preoperative tests that don’t make clinical sense.
Use evidence-based guidelines to drive testing decisions.
Share with patients the reasons for avoiding over-testing.

Clinicians can prevent overtesting by fostering stronger patient relationships, sharing the rationale behind not ordering unnecessary tests, and practicing more judicious care. Education and training can also help reduce reliance on excessive testing, allowing clinicians to make more informed, confident decisions. Physicians reported using a variety of tactics to overcome uncertainty in ordering and interpreting laboratory tests as seen in the figure below⁴.

Addressing the Problem

Advanced Health Academy (AHA) offers a solution by providing comprehensive interpretations of the most common lab tests. With better clarity in lab results, AHA helps reduce unnecessary follow-up testing, increase provider and patient confidence regarding diagnosis and treatment, minimize patient anxiety, and improve overall healthcare efficiency. Practices using AHA can optimize revenue while lowering healthcare costs for providers and payers, increase operational efficiency, and improve patient outcomes, by making it easier to prevent the downstream negative effects of overtesting.

As the healthcare industry continues to address this issue, AHA is paving the way toward smarter, more efficient, and patient-centered healthcare.

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