India, Sept. 2 -- Gallbladder removal or cholecystectomy is among the most commonly performed surgeries in India. A 2026 BMJ Public Health review by Mohite et al., estimated that about 32 lakh cholecystectomies were performed in India in 2022 alone. Extrapolating from these estimates suggests that nearly 1.8 crore people may have undergone this surgery, during the five-year period from 2021 to 2025. India doesn't have a comprehensive national registry of surgeries. Cholecystectomy is often considered a tracer procedure for excess and unnecessary surgeries in India. The implications for patients are important. Gallbladder removal is, in most cases, performed because of stones in its lumen. These stones, called gallstones, are the hardened deposits made of cholesterol or bile pigments. The risk of developing gallstones rises with age, genetics, obesity, rapid weight loss, including from weight-loss medicines, pregnancy, hormonal factors, and metabolic patterns. Yet most gallstones never cause symptoms. They are incidental findings during an ultrasound performed for fatty liver, acidity, abdominal discomfort, urinary complaints or an annual health check-up. A diagnosis of gallstones does not automatically require surgical removal. International guidelines recommend observation for asymptomatic gallstones when the gallbladder and bile ducts are otherwisenormal. Surgery is beneficial when stones cause repeated biliary pain, acute inflammation, bile-duct obstruction or pancreatitis. Preventive removal may be consideredin selected high-risk situations. For theaverage person with an incidental, symptom-free stone, however, wait-and-watch isthe appropriate approach. Actual surgical practice in hospitals in India is very different. Once an ultrasound report reads 'multiple gallstones', a nudge towards surgery is often given. The patient worries that a stone may suddenly become dangerous. The procedure is usually laparoscopic, widely available, requires a short hospital stay and is often covered by health insurance. Together, these factors make surgery feel safer even when doing nothing is an equally effective option. This is where a clinical question becomes a health-system question. Much of India's corporate health care operates through a fee-for-service model. Hospitals earn from investigations, admissions and procedures. Health insurance packages can reinforce these incentives because reimbursement is easier to define for an operation than for observation, counselling, and follow-up. This does not mean doctors or surgeons operate with bad intentions. Cholecystectomy is an excellent operation when medically indicated. Yet systems influence clinical thresholds. When financial, institutional and psychological incentives point towards intervention, while almost none rewards restraint, unnecessary treatment and surgery can become easier without anyone consciously deciding to overtreat. Then, surgery, or any procedure on the human body, is never without risk. Laparoscopic cholecystectomy is considered safe, but complications can include bleeding, infection, anaesthetic problems and bile-duct injury. Some patients experience abdominal pain, indigestion or altered bowel habits after gallbladder removal. These risks are acceptable when surgery relieves recurrent pain or prevents complications. That is why one should not rush to remove the gallbladder at the first diagnosis of gallstones. Gallbladder removal is only one example. India has very high Caesarean-section rates, particularly in private hospitals. Unnecessary hysterectomies among low-income and rural women have prompted government concern, media attention and ethical questions. Similar concerns arise around angioplasty and stenting in stable coronary disease, spinal fusion for uncomplicated back pain, knee replacement before conservative treatment, some appendectomies and tonsillectomies, and endoscopies or scans that may never alter treatment. Many of these interventions are lifesaving or life-changing. The issue is the threshold at which they are offered. Health care once usually began with symptoms. A patient became unwell, visited a doctor and was investigated. Over the last two decades, with the growth of corporate hospitals, that sequence seems to have reversed. Healthy people are tested and investigated, the risk factors are treated as full disease, and a health package produces an abnormality that gives the person a disease label. The label creates anxiety, generating specialist visits, repeat tests, medicines and sometimes procedures. Over three decades, India's hospital sector has expanded alongside another booming industry: ultra-processed food. We are consuming more of both fast food and fast medicine. Both are sold as convenience and are mistaken for economic progress and societal development. In fast medicine too, the sequence is business-efficient: test, diagnose, prescribe, and operate. India needs advanced diagnostics, skilled specialists and excellent surgeons. But it also needs slow medicine. Slow medicine does not mean delaying necessary care. It means moving quickly when treatment clearly helps and proceeding deliberately when evidence supports observation. It values clinical judgement, continuity, explanation, second opinions and informed consent. It asks a question modern health care often forgets: What is likely to happen if we do nothing? Reports of unnecessary surgeriesand procedures appear regularly in India,yet the country lacks a national systemtelling us precisely how many electiveoperations are performed, for what indications, and how many were truly necessary. Better data, smarter insurance design and stronger primary care are essential to halt and reverse this trend. India's health care challenge is not merely to learn how to do more. A mature health system must value restraint as much as intervention. The best doctor is sometimes the one who explains why an operation is unnecessary; the best surgeon is the one who knows not only how to operate, but when not to. Patients and families have a role too.Many patients want, demand or seek to get surgery done. Before an elective procedure or intervention, every person should ask: Do I truly need this now? In medicine and surgery, progress is measured not only by how much we can do, but by how wisely we know when to stop....