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