Table 2.

Negative effects of overuse. Case examples in each domain.

Negative Effect Domain	Example
	Clinical scenario	Negative effect
Physical	Unnecessary CT angiography showed CAD, which led to coronary angiography and ultimate 3-vessel coronary artery bypass graft surgery (CABG)39	Heart failure as a complication of the CABG
Psychological	Unnecessary thrombophilia testing after a provoked DVT, with “abnormal” findings that were not clinically meaningful40	Significant worry about passing rare disorders on to her children
Treatment burden	Overly tight control of type 2 diabetes with insulin led to multiple episodes of hypoglycemia and related anxiety41	Sense of being overwhelmed, inability to fully engage in care
Social	Unnecessary hospitalization for arthritis in an elderly woman27	Prolonged inpatient rehab stay with removal from usual enjoyable social activities
Dissatisfaction with healthcare	Unnecessary FFP for an asymptomatic supratherapeutic INR led to a severe transfusion reaction42	Patient was distressed by the reaction and openly questioned the need for the transfusion
Financial	An elderly man was taking over 50 dietary supplements as recommended by his physician43	Annual out of pocket cost of $36,000, despite limited income