It is at least conceivable that the patient in this case would be a legitimate outlier for whom ordering the CT scan would not be “low-value.” For example, the patient’s willingness to pay for the CT scan is relevant insofar as it may reflect the degree to which the patient’s fear is leading to a reduced quality of life. If the patient’s general well-being was substantially reduced by worry, be it rational or irrational, this could make the CT scan far more cost effective for this particular patient than for patients overall (eg, through reductions in downstream use of resources to help alleviate anxiety and stress). Importantly, this is not an argument that health-care services ought to be allocated according to the ability or willingness of patients to pay. I do not even advocate routine inquiries regarding whether patients would be willing to pay for services as a means of determining how important the service is to patients. However, physicians are practicing good medicine when they consider the unique elements of a case and consider whether there exist objective reasons to think that a particular patient differs from those in whom the service is known to be of low value. Policies that allow for such individualized care, while also strongly encouraging major reductions in use for the far more common cases that better align with the guidelines, are similarly responsible. But to be effective and defensible, policies that would monitor physicians’ use rates (and potentially reimburse accordingly) must be carried out at the physician, or even practice, level, not at the level of individual patients.