Snapshots of low-value medical care.

H AVE YOU EVER HAD a magnetic reso-n a n c e i m a g i n g (MRI) scan of your brain? I have. I was lying on a plank in my underwear and a hospital gown, with a cold peripheral intravenous (IV) line in my arm and a woolen blanket draped over me. A plastic cage was closed on my face to steady my head, and headphones with thick cushions covered my ears, playing the Dave Matthews Band inaudibly. I was slid into a narrow tube where I was rattled by a deep pulsating buzz. It was suffocating. Normally I would have torn off the headgear, kicked off the blanket, and run to escape. But I couldn't. I took the time to get this test, so I wanted to ensure it was " motion artifact " free. The test continued for 30 minutes. I had moments of calm punctuated by blips of terror. I wanted to scream. How did I get here? Two years ago, I went to an op-tometrist. It was years since my last visit, and I figured I needed new glasses. My prescription changed, but more importantly the optom-etrist detected optic disc pallor and a " restricted gaze. " She recommended an ophthalmologist. In our discussion, she emphasized it was probably nothing. I had no symp-toms—no double vision or headaches. I told her I'd consider going but never went. I felt fine, and as an internist and epidemiologist, I was wary of testing when the indications were unclear. One year later, I went back. I hadn't had time to select new glasses at my last visit, and I also wanted to see if my examination results changed. If they had worsened, I'd take her advice. Fortunately, my examination results were unchanged, and I remained asymptomatic, but my optometrist still wanted me to see a specialist. So I went. I thought the findings might be easily dismissed, putting the issue to rest. I was wrong. The ophthalmologist was under-whelmed 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 neurovascu-lar disease, masses compressing my fourth cranial nerve, and thyroid disease causing ocular muscle hy-pertrophy. We agreed that these diagnoses were extremely unlikely because I had no symptoms and no changes in examination findings over 2 years. …