Do the right medicine, for the right person, at the right time.
For generations, the rhythm of aging in America has included a familiar drumbeat of routine screenings and preventive procedures — not because each one was proven to help every patient, but because more medicine came to feel like better medicine. Now, a growing body of evidence and a chorus of thoughtful clinicians are asking whether some of these rituals, applied uniformly to people in their seventies, eighties, and beyond, may do more harm than good. The New York Times has brought this quiet reckoning into public view, inviting older adults and their doctors to replace the checklist with a conversation — one rooted in individual values, honest data, and the question of what a good life actually looks like.
- Millions of older adults undergo routine medical procedures each year that rigorous research suggests offer little measurable benefit — and sometimes introduce new risks.
- False positives, unnecessary biopsies, procedural complications, and the psychological weight of ambiguous diagnoses represent real harms hiding inside well-intentioned care.
- The financial strain is equally concrete: overtreatment quietly inflates costs for patients, families, and a healthcare system already buckling under the demands of an aging population.
- Physicians and researchers are pushing for shared decision-making — a model where patients receive honest data about risks and benefits and then choose care aligned with their own priorities.
- The movement is gaining ground, pointing toward a future where aging care is measured not by the volume of procedures performed, but by how well it serves the person receiving it.
The waiting rooms of American medicine are filled with older adults following routines they were told to follow decades ago — and rarely asked to question. A recent New York Times investigation examined three common medical practices embedded so deeply in aging care that neither patients nor providers typically stop to ask whether the evidence still supports them.
The underlying assumption for years was straightforward: more screening, more testing, more prevention equals better outcomes. For older adults, the logic felt especially sound — catch disease early, prevent complications, extend life. But when researchers examined the data closely, the picture grew complicated. Some of these procedures, performed millions of times annually on people in their seventies and eighties, showed little benefit in rigorous studies. And some caused genuine harm: unnecessary anxiety, false alarms, invasive follow-up procedures, and complications from treatments that were never truly needed.
The deeper problem is uniformity. These practices are often applied as one-size-fits-all protocols when they should be tailored conversations. An eighty-five-year-old managing multiple chronic conditions may have entirely different priorities than a seventy-year-old in excellent health — and both deserve care shaped around what they actually want from their remaining years. The current system frequently denies them that choice.
The costs of overtreatment are real and layered: financial burdens from unnecessary procedures, physical risks from interventions triggered by false positives, psychological harm from diagnoses that turn out to be nothing, and the quiet opportunity cost of time spent in medical offices rather than living.
The answer, according to the clinicians driving this shift, is shared decision-making — providers presenting honest data, patients weighing it against their own values, and both arriving at care that fits the individual rather than the protocol. It sounds simple. But for a healthcare system long conditioned to default to doing more, it represents something genuinely radical: the idea that the right medicine, for the right person, at the right time, is always better than more medicine for everyone.
The waiting room is full of people over seventy, many of them there for the same reason: a routine they've been told to do for decades. But increasingly, doctors are asking a harder question—does this actually help? The New York Times recently examined three common medical practices that have become so embedded in aging care that few patients or providers stop to ask whether the evidence supports them.
The shift reflects a broader reckoning in medicine. For years, the assumption was that more screening, more testing, more prevention meant better outcomes. For older adults especially, the logic seemed sound: catch problems early, prevent complications, extend life. But when researchers began looking closely at the data, they found something more complicated. Some of these routines, performed millions of times a year on people in their seventies, eighties, and beyond, showed little benefit in rigorous studies. Worse, they sometimes caused harm—unnecessary anxiety, false alarms, invasive follow-up procedures, or complications from treatments that weren't needed in the first place.
The problem isn't that these practices are wrong for everyone. Rather, they're often applied as one-size-fits-all protocols when they should be decisions made between a patient and their doctor, tailored to what that particular person actually wants from their remaining years. An eighty-five-year-old with multiple chronic conditions may have very different priorities than a seventy-year-old in excellent health. One might want aggressive screening to catch disease early; another might prefer to avoid the stress and disruption of frequent testing. Neither is wrong. But the current system often doesn't give them that choice.
This matters because overtreatment carries real costs. There's the financial burden—unnecessary procedures add up quickly in a healthcare system already straining under the weight of aging populations. There's the physical toll: a false positive on a screening test can lead to biopsies, imaging, or other interventions that carry their own risks. There's the psychological weight of being told you might have a disease, only to learn later the finding was a false alarm. And there's the opportunity cost—time and energy spent on routine care that doesn't align with a person's actual health goals.
The solution, according to the evidence and the doctors pushing for change, is shared decision-making. This means providers presenting patients with the actual data: here's what we know about this screening, here's what it might find, here's what we'd do if we found something, here are the risks and benefits. Then the patient decides, based on their own values and circumstances. It sounds simple, but it requires a fundamental shift in how medicine approaches aging. Instead of a checklist of things everyone should do, it becomes a conversation about what matters to you.
This approach could reshape aging care. It might mean fewer unnecessary procedures, lower costs, and better quality of life for older adults who spend less time in medical offices and more time doing things they actually value. It might also mean some people choose screening they currently aren't getting, because they understand the evidence and want it. The point isn't to do less medicine—it's to do the right medicine, for the right person, at the right time. For a healthcare system that has long defaulted to doing more, that's a genuinely radical idea.
A Conversa do Hearth Outra perspectiva sobre a história
Why do these routines persist if the evidence doesn't support them?
Inertia is powerful in medicine. A practice becomes standard, gets taught to the next generation of doctors, becomes what patients expect. Nobody stops to question it until someone actually looks at the data.
But don't doctors know the evidence?
Some do. But there's also liability—if you don't screen and something goes wrong, a doctor might face a lawsuit. And there's the simple fact that screening feels like doing something good, even when the data says it's neutral or harmful.
What changes a patient's mind about wanting a routine they've done for years?
Usually, a conversation. When someone explains that a test they've been getting has never changed their treatment, or that the risks of follow-up procedures outweigh the benefits, people often reconsider. They just need permission to opt out.
Does this mean older people should stop all preventive care?
Not at all. It means being intentional. Some screening is genuinely valuable. The question is: for whom, and for what goal? That's a conversation between a patient and their doctor, not a protocol applied to everyone.
What's the biggest barrier to making this shift?
Time and money. Shared decision-making takes longer than checking boxes. And the system doesn't always reimburse for conversations the way it does for procedures. That has to change.