Doctors have a diagnosis for what's wrong with healthcare in the United States: there's too much of it.
In a poll of US primary care physicians published in the Annals of Internal Medicine, nearly half of them said their patients received too much medical care and more than a quarter said they were practising more aggressively than they'd like to.
This could mean ordering more tests, prescribing more drugs or diagnosing people with diseases, although they would never have experienced any symptoms.
"Physicians at the frontline of medical care are telling us that their patients are getting too much care," said Brenda Sirovich of the VA Medical Center in White River Junction, Vermont, who worked on the survey.
"And we don't think we are just talking about the 627 physicians we surveyed."
By contrast, just six percent of doctors believed their patients were getting too little care.
The findings come at a time when the healthcare budget is already overstretched and many fear it is about to spiral out of control.
"We spend a lot on healthcare in this country, more than anywhere else," said Sirovich, who is also at the Dartmouth Medical School. "We realise that this is unsustainable."
According to the Organisation for Economic Cooperation and Development (OECD), the United States spend $US7960 per capita on healthcare in 2009 - $US2608 more than Norway, the runner-up.
In an article published along with the poll, one doctor recounted the story of a man who developed intractable pain after falling on an icy driveway. He had several tests at a hospital, but all came up negative.
All along, the man's wife had been telling doctors that her husband had a morphine pump in his back to help treat chronic pain and that he'd fallen onto the pump. But nobody listened.
The prescription? Doctors should listen to their patients, wrote Philip Wickenden Bale of the T J Sampson Hospital in Glasgow, Kentucky.
"Much science and technology, with associated expense, was used to eliminate conditions he didn't have, while the art of listening well might surely have led to a faster, cheaper remedy," he wrote.
Excessive testing may also lead to diagnosing conditions that would never have caused any problems, such as a slowly developing prostate cancer or slightly elevated blood pressure.
Yet after such a diagnosis it's difficult for doctors not to proceed to treatment, which may cause side effects.
"When you do anything to somebody, whether it is an intervention or a test, you are putting them in the healthcare system in a way that exposes them to risk," said Sirovich.
"Unnecessary care is potentially harmful."
According to the survey, doctors order tests they themselves believe are excessive for three reasons: fear of malpractice lawsuits, performance measures and too little time to just listen to patients.
Four in 10 of the doctors surveyed in the random sample believed that other primary care physicians would order fewer tests if those tests didn't provide extra income. Just three percent thought that financial considerations influenced their own practice style.
"I'm not saying that physicians do tests in order to make money - there is a potential to be a real cynic here - but I think that the reimbursement model for most healthcare encourages utilisation in a variety of ways," Sirovich said.
"It's a time for us to reflect about what incentives we have built into our healthcare system, and what directions they are taking us in."