Why Wait? Why Not Just Test and Treat Right Away?

Occasionally, the most effective “cure” for certain conditions is simply the passage of time. This is one rationale behind many doctors recommending watchful waiting rather than pursuing aggressive testing. The concept underscores that knowledge becomes empowering only when there are actionable steps that can be taken. In numerous instances, conditions may not warrant awareness or intervention until they manifest noticeable symptoms.

In alignment with these principles, the American Board of Internal Medicine Foundation introduced the Choosing Wisely campaign in 2012. The campaign is driven by the mission to promote more discerning, evidence-based approaches to testing and treatment while discouraging unnecessary and excessive medical tests and interventions.

Six conditions for which early detection and treatment isn’t clearly helpful

Certain conditions may not necessitate immediate or aggressive treatment, and in some cases, a “watch and wait” approach may be appropriate. Here are examples of such situations:

1. Certain Leukemias and Lymphomas:

• Context: Some leukemias and lymphomas progress slowly, and the risks associated with treatment may outweigh the benefits.
• Example: Early-stage chronic lymphocytic leukemia causing no symptoms may not require therapy.

2. Sarcoidosis:

• Context: Sarcoidosis, a condition of unknown cause, may result in enlarged lymph nodes and organ inflammation.
• Example: When there are no symptoms, normal physical examination findings, and routine test results are normal, treatment may not be necessary.

3. Some Types of Prostate Cancer:

• Context: Prostate cancer confined to the prostate gland with a nonaggressive appearance may be closely monitored without immediate treatment.
• Example: Men with localized prostate cancer may opt for active surveillance rather than immediate intervention.

4. Osteoarthritis:

• Context: Osteoarthritis, the most common type of arthritis, may not warrant treatment if symptoms are mild.
• Example: Management may focus on lifestyle modifications and symptom relief rather than aggressive medical intervention.

5. Mildly Elevated LDL Cholesterol in Low-Risk Individuals:

• Context: Individuals with low cardiovascular risk and slightly elevated LDL cholesterol may be managed with lifestyle changes rather than medication.
• Example: Recommendations may include regular exercise, weight management, and a healthy diet, without immediate reliance on medication.

6. Common Cold and Viral Infections:

• Context: Many viral infections, including the common cold, often resolve on their own without specific medications.
• Example: Supportive measures, such as rest, fluids, and fever reducers, are usually employed without the need for specific antiviral treatments.

In these instances, the emphasis is on a cautious and tailored approach, ensuring that interventions align with the potential risks and benefits, and treatment decisions are based on the individual characteristics of the condition and the patient.

When not to wait: Tests to rule out a serious diagnosis

When there is a substantial concern about a potentially serious condition where early detection and intervention could be impactful, healthcare providers should prioritize expeditious investigation.

For instance, if a chest x-ray identifies an anomaly indicative of cancer, prompt follow-up assessments should be organized. Even if the subsequent examinations reveal no evidence of cancer, the swift clarification does not render the initial testing superfluous. The primary rationale for recommending tests is often the swift exclusion of a troubling diagnosis that appears plausible, thereby ensuring timely peace of mind or facilitating necessary early interventions.

What about testing for peace of mind?

When someone feels unwell without a clear cause, it’s natural to experience worry, distress, or even depression. The desire for a diagnosis or the exclusion of certain conditions can bring immense relief and reassurance.

However, it’s crucial to note that providing reassurance doesn’t always necessitate extensive testing. For instance, in the case of recent back pain without accompanying symptoms or abnormalities, recommending imaging tests like an MRI may be unnecessary, given the low likelihood of detecting a serious issue. Conducting extensive and costly imaging, in such cases, can be superfluous and may even escalate anxiety if an insignificant incidental finding is uncovered.

The concept of reassurance through early detection has been exploited by entities seeking profit. Some imaging centers market scans and tests independently of a physician’s guidance. These fear-inducing advertisements depict potential catastrophic scenarios within the body, urging individuals to spend substantial sums for supposed “peace of mind.” It’s essential to recognize that such testing is often unhelpful and carries potential risks.

Similarly, certain organizations provide executive leaders with medical testing beyond standard care as an executive perk. The idea is to conduct body scans in search of early diseases for proactive treatment. However, such testing comes with inherent drawbacks and may not be as beneficial as perceived, challenging the notion of it being a genuine perk.

Early detection and treatment can be lifesaving — just not for every health issue

Indeed, in numerous medical scenarios, early diagnosis holds significant advantages, particularly when effective treatments are most potent during the initial stages of an illness. Conditions like breast and colon cancer exemplify this principle, where early detection through screening tests such as mammography and colonoscopy can lead to successful treatment and even cure if the tumor is identified before progressing to an untreatable, fatal stage.

Moreover, noncancerous conditions also benefit from early diagnosis and intervention, contributing to improved outcomes. Conditions like rheumatoid arthritis, appendicitis, and bacterial pneumonia serve as noteworthy examples where prompt identification and treatment can positively influence the course of the disease.

The bottom line

The significance of early diagnosis and treatment is evident in certain conditions, yet for others, it might be overstated. There is a valid argument that our capacity to conduct tests has surpassed our ability to accurately interpret the results. Just because we have the capability to test for hundreds of diseases doesn’t necessarily imply that we should.

Traditionally, the culture of American medicine has leaned towards the belief that “more care — and more testing — is better care.” However, with escalating healthcare costs not correlating with proportional improvements in health outcomes, it’s prudent to reassess this assumption. If you’re feeling unwell or have health concerns, discussing your situation with your doctor is essential. However, it shouldn’t be surprising if they recommend no specific treatment or testing. A plan that involves allowing time to pass with close follow-up could potentially save you the expenses, anxiety, and risks associated with unnecessary care.