Watchful Waiting as a Treatment Modality for Medical Conditions

Observation and monitoring (OAM) as a treatment modality for medical conditions means that an appproach of watchful waiting (WW) or watch and wait (WAW) or wait and see (WAS) is utilized for a medical condition that will most likely or even may spontaneously resolve or regress.  The approach can also be used in medical condition that may not need active medical treatment after all.

The indication for OAM, WW, WAW, and WAS consists of a non-immediate life-threatening medical condition that may be observed and monitored because of a significant probability that the medical condition will and may spontaneously resolve or regress without needing active treatment or that medical condition, even if it does not resolve or regress spontaneously, may not need active medical treatment after all.

Possible outcomes after OAM, WW, WAW and WAS consist of the following:

  1.  The medical condition spontaneously resolves or regresses.
  2.  The medical condition may not need active medical treatment after all even if it does not spontaneously resolve or regress, just continue to observe and monitor.
  3. The medical condition may need active treatment after all because of new development and change of diagnosis and it is not too late to institute it.

There are two other different concepts of observation and monitoring that are being used in medicine.  One is observation and monitoring during the course of an active treatment to evaluate the response.  The other is observation and monitoring in the Department of Emergency Medicine or Emergency Room to see whether the patients can be discharged or have to be admitted.

From hereon, I will use Watchful Waiting or Watch and Wait (WAW) to differentiate the first concept from the two other concepts.

How long is WAW?   It all depends on the diagnosis of the medical condition and estimate of probability for spontaneous regression and for a benign condition that may not need active treatment. It can range from several hours to as long two to four weeks or even longer.

When doing WAW, close and constant observation and monitoring is the name of the game.  The patient can be empowered to do the WAW.  However, it is advisable that it also be done under the supervision of a physician.

During the WAW, symptoms (felt by patient) and signs (objective evidences) are closely and constantly observed and monitored.  It is advisable that progress notes on symptoms and signs are done on a planned interval, say daily or after 3 days or after one week, etc.  It is also advisable to take serial photograph of the medical condition if it can be visually seen, measured and evaluated.

Lastly, during the WAW, if there is progression of the symptoms and signs and if there is a change in diagnosis to one that needs active medical treatment, then WAW should be cut short or aborted and active medical treatment instituted.

Some examples:

38-year-old female with recent onset (one week) of rashes on the areola of the breast.  Diagnosis: contact dermatitis. WAW instituted – the rashes spontaneously resolved with change of bra after 2 weeks.

60-year-old female with recent onset (about a week) of thyroid nodule, 1.5 cm.  Diagnosis: colloid cyst. WAW instituted – in one month’s time, the nodule spontaneously disappeared.

57-year-old female with a less than 1-cm neck node on the left.   Diagnosis: non-specific lymphadenopathy.  WAW instituted – 10 years after, the node has stayed stationary.  No need to be excised. Just continue WAW.


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