The epidemic of low-value care

The ophthalmologist was underwhelmed by my findings. But “just in case,” he wanted a brain MRI scan, eye ultrasonography, and a visual field test to rule out multiple sclerosis (MS), subclinical neurovascular disease, masses compressing my fourth cranial nerve, and thyroid disease causing ocular muscle hypertrophy. We agreed that these diagnoses were extremely unlikely because I had no symptoms and no changes in examination findings over 2 years. But he “wanted to make sure.”

I tried to understand and put myself in his place. But it was difficult, because he seemed so unimpressed. Even if I had MS or vascular disease, I wouldn’t do anything differently. I was already getting blood pressure checks and was taking a statin for a family history of early heart disease. An intracranial mass also seemed unlikely given the duration and asymptomatic nature of my findings. But despite my own medical and epidemiologic training, it was difficult to resist his advice. As my physician, his decision making was important to me. I trusted his instincts and experience.

– Craig A. Umscheid, MD, MSCE. Being a physician does not confer immunity from clinical capture disease.


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