"Less is more" in medicine is an invitation to recognize the potential risks of overuse of medical care that may result in harm rather than in better health. It is indeed necessary to eliminate unnecessary and costly practices by streamlining care without rationing. However, several barriers and challenges for the implementation of less is more medicine have been identified in Switzerland, where overuse is rooted in our culture and demanded by a society that requests certainty at almost any cost. Patients' high expectations, physician behavior, lack of monitoring and pernicious financial incentives have all indirect negative consequences for medical overuse. Multiple interventions and quality-measurement efforts are necessary to widely implement less is more recommendations. These include financial incentives, patient education, physician behavior change with data feedback, communication training and systems interventions. A quality-oriented approach can be an intellectual challenge but also a real opportunity to promote sustainable medicine.