“Watchful waiting” is an expression used in medical practice for simply monitoring some unknown or simple medical condition without subjecting the patient to multiple testing, multiple procedures or unnecessary and perhaps risky medical or surgical treatments. This relatively inexpensive and unsophisticated method of medical practice for selected medical conditions is one way that the medical profession can maintain beneficence for the patient but also, at the same time, reduce the cost of all medical care in the United States. But it is also something that patients and their doctors must accept.
In these current days where our government is trying to find an answer to fixing or reducing the cost of medical care yet improving all aspects of quality, “watchful waiting” may be a possible solution. After all, not all runny noses and sore throats need antibiotics to resolve, not all isolated mild first time gall bladder attacks need surgery, not all chronic low back pain need spinal surgery and current evidence suggest that mildly elevated PSA values does not require prostate biopsy nor all detected prostate cancer require immediate surgery or radiation and particularly if discovered in the elderly.
So what are the arguments against and for “watchful waiting”? How about patient satisfaction? Will patients accept this decision? Well, there has been a study on this very point published recently in the Annals of Family Medicine
where patients with unexplained complaints were either given a blood test at once or given education and observed over a 4 week period before a blood test was taken. The conclusion: “Test-ordering strategy does not influence patients' satisfaction with and anxiety after a consultation. Instead, specific aspects of physician-patient communication are important” What this means is in this one study, delay of testing for the yet unknown cause of the symptoms was tolerated by the patients.
On the other hand, a lawyer’s view
of watchful waiting regarding prostate cancer might be one of cautioning potential clients to this decision and encourage them toward litigation if the outcome is unfavorable. Finally, the management of diagnosis and treatment of prostate cancer including "watchful waiting" will be to David Leonhardt, writing in the July 7 2009 issue of the New York Times
, his litmus test about whether the Congress and the government is willing to change the basic economics of healthcare. Read his enlightening article and then return with your conclusions.
Are you asking your doctors to do too much, too soon and at too great a cost? Are your doctors doing too much too soon for additional income or because of malpractice worries? Do you see a role for “watchful waiting?” ..Maurice.