Management options can be broadly divided into
- Directed/Specific treatment e.g. angioplasty for MI
- Empirical treatment (treatment covers likely possibilities) e.g. broad spectrum antibiotics for bacterial meningitis
- Expectant / Supportive treatment (treatment is not reliant on precise aetiology or diagnosis) e.g. fluid hydration for infectious diarrhoea
- Therapeutic trial (diagnosis inferred by response to treatment) e.g. metronidazole for chronic diarrhoea: positive response = Giardiasis
Making Management decisions
- Expectant therapy is reasonable if the natural history of disease is self-limiting and relatively benign
- A therapeutic trial is reasonable if the risk of the treatment is small compared to the benefit of the treatment.
- Directed / Specific treatment required if the treatment has both high benefit but also significant risk.
- Empiric treatment required if the risk of not treating is high versus benefit of treating
MICLO
Occasionally doctors choose to do nothing with their patient because they are waiting for more information to come to hand:
- for more symptoms or signs to develop so the diagnosis is clearer
- for test results to return
- to allow current treatment to take effect *
Waiting is reasonable if::
- The hypothesized disease(s) is not going to abruptly worsen (with or without current treatment) *
- There is careful observation and good followup
- The patient (or carers) knows what to look out for and will respond appropriately (patient education / staff instructions)
MICLO = Masterful Inaction and Cat Like Observation
But good practice needs the -CLO not just the MI-
* therefore MICLO only works if you know how long it usually takes for the treatment to work and how severe the condition is or how quickly it will progress