Management options
Management decisions are based on risk:benefit of not treating vs treating
Management options for any disease can be divided into:
- Directed/Specific treatment e.g. angioplasty for MI
- Empirical treatment (treatment covers all likely possibilities) e.g.
broad spectrum antibiotics for bacterial meningitis
- Expectant / Supportive treatment (treatment ignores the precise
aetiology) e.g. fluid hydration for infectious diarrhoea
- Therapeutic trial (diagnosis inferred by response to treatment) e.g.
metronidazole for chronic diarrhoea: positive response = Giardiasis
- 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