Talk:Watchful waiting
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[edit] Watchful waiting vs Medical observation
(Copied from Wikipedia talk:WikiProject Medicine#Watchful waiting. --Una Smith (talk) 02:52, 27 May 2008 (UTC))
The above article has been moved to Medical Observation, without discussion, for the second time in two weeks. I am of the opinion that "medical observation" is waaay too broad a term to be considered synonymous with watchful waiting, not to mention far less established. Any thoughts before I revert the move—again? Fvasconcellos (t·c) 21:55, 26 May 2008 (UTC)
- "Watchful waiting" doesn't necessarily imply medical, though all of the first page of google hits are on that term and cancer and I've never heard it any other context. Medical observation implies inpatient to me, whereas watchful waiting sounds more like the outpatient experience. Sounds like there very well could be two articles, or one article that includes both concepts. I don't see a burning need to have the main article be at either location.Somedumbyankee (talk) 22:11, 26 May 2008 (UTC)
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- Historically, medical observation was a very broad concept. The modern concept is quite narrow and refers to close monitoring in an attempt to "capture" a fleeting sign or symptom. Neither of those concepts has much in common with watchful waiting. Re the historical concept, see Lectures on the Principles and Methods of Medical Observation and Research, published in 1857.[1] --Una Smith (talk) 02:49, 27 May 2008 (UTC)
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- Really? I wasn't aware of these subtle differences between "medical observation" and "watchful waiting". The reference adduced is from the Australian Prostate Cancer Collaboration. This website clearly provides much helpful information about prostate cancer. However I am not convinced that it reliably confirms the distinction between "medical observation" and "watchful waiting". Axl (talk) 15:43, 28 May 2008 (UTC)
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- "Medical observation" includes "Because of the possibility of a head injury, we admitted the child to the hospital for observation overnight," which is clearly different from "You have a very slowly progressing condition, and it doesn't warrant treatment at this time." WhatamIdoing (talk) 06:01, 29 May 2008 (UTC)
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- Is there a reliable reference that states this? Axl (talk) 12:06, 29 May 2008 (UTC)
- Can I find sources that say that hospital stays are used for some kinds of "medical observation"? Sure. I'm not sure I can find really great sources, but this study (page 4) refers to "medical observation" with a footnote that it was specifically "Overnight observation post-cardiac catheterization," and this poison-control paper talks about the "overnight medical observation of toddlers."
- This page on billing codes requires "a medical observation record" and gives codes for overnight and non-overnight observation in both inpatient (admitted to the hospital) and outpatient (not technically admitted, but still at the hospital) settings, and this pleads with docs to specify in the order whether its inpatient or outpatient instead of making the billing people guess based on whether the order is an admission "to observation" or "for observation." This problem, of course, wouldn't exist if all medical observation was restricted to slowly developing outpatient situations, like prostate cancer or chronic blood cancers. You could have a "watchful waiting" situation that just involves a simple blood test every six or twelve months. Not all medical observation is like that.
- Note that I believe that "watchful waiting" is a subset of medical observation. My point is primarily that if you have a child who got beaned by a baseball, you wouldn't tell the parents that you were keeping the kid overnight for the purpose of "watchful waiting": that child is in for medical observation. WhatamIdoing (talk) 05:36, 30 May 2008 (UTC)
- Is there a reliable reference that states this? Axl (talk) 12:06, 29 May 2008 (UTC)
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There is obiously a conflict between those who believe that "Watchful Waiting" should be moved to "Medical Observation" I am the one moving, I have not heard the term "Watchful Waiting" used in many years. I would understand that if we had moved "Watchful Waiting" to just a page titled Observation, then it would be a "broad concept". But since I moved it to medical observation, then it is not a "broad". Just because a person is admitted to Medical Observation does not mean that they are only going to be monitored, when we admit patients into observation, sometimes we are putting stents in the heart or a simple cardio-vascular procedure that would not require admitance to inpatient status but not as subtle as a Lunbar Puncture that they would stay as an ER patient. Or other times when the patient is having a test done that would take more than 24 hours, than they will be put into the medical observation unit to see the results of the test. Even though they are admitted under observation, this doesn't mean that they are not like an inpatient. I see this all the time, for example, the telemetry unit always has inpatient and observation patients mixed in the unit. I don't know, I just thought we would catch up with the times and use "Medical Observation" in lieu of "Watchful Waiting", I don't have any evidence to prove my opinion other than experience, let me know your thoughts. im kind of new to this so im gonna move the page to get your attention to discuss this.--Teledoc12 (talk) 02:06, 30 May 2008 (UTC)
- WhatamIdoing, I see that the phrase "medical observation" is used in these studies. However is it really notable enough to be worthy of its own entry in Wikipedia? The Journal of the Oklahoma State Medical Association article (repeated by level1diet) does not mention "medical observation", although perhaps this is implicit in the context. I have looked in a few eminent sources (including the Oxford Textbook of Medicine and Harrison's Principles) but I couldn't find a specific reference to "medical observation" or "watchful waiting" as management options. By your definitions, it is clear that both of these processes occur, but are they really notable? Axl (talk) 09:19, 30 May 2008 (UTC)
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- I see what the problem is Axl is from the UK and, well I dont know about you other people, but im from the US, now I see there are differences between the two countrys in Medical Terminology.
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- Axl, personally, I might choose Observation (medical) as the article title for the general concept, and include all the variations. But that's just me. I think we need an article about the thing itself, instead of the phrases used to describe it.
- As for finding sources, there are a number of studies that compare various interventions to "observation" (ie, doing nothing), and it is the strategy of choice for many conditions, from ear infections ("Come back in two weeks if it hasn't cleared up") to cancer ("Let's check your PSA level again in about three months"). I doubt that a textbook would have a page on 'how to do medical observation', because the specific needs would vary according to condition. So you won't find a page on the general concept, but you will find dozens of conditions that use this 'technique'. WhatamIdoing (talk) 16:25, 30 May 2008 (UTC)
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- Well, I don't know if the terminology is significantly different in our different countries. In any case, I suspect that this terminology is fairly loose anyway, so different individuals may imply different meanings depending upon the context. Hence why I am asking for a reliable source that describes the difference. In general, I do not consider articles that happen to mention "medical observation" or "watchful waiting" to be reliable sources. This is because the reader has to infer the meaning from the context, i.e. circumstantial evidence. Axl (talk) 17:01, 30 May 2008 (UTC)
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- I agree with whatamidoing, we should make a page just titled "Observation" (Medicine) and include different variations, such as my hospital where we have "Medical Observation", "Surgical Observation", "Neurological Observation", "Labor and Delivery Observation", each one with its own criteria which must be met before admittance as with, for example, "Surgical Observation", where a patient has developed a low grade post-op fever so we will admit him under Surgical Observation overnight, or in our policys case, for 24 hours to see if he has an infection or not. I am up for the project if anyone else is. --Teledoc12 (talk) 03:14, 31 May 2008 (UTC)
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- Your list of the different applications for observation as a medical technique is, I think, a good place to begin. Could we start that now (do you have useful sources?), and worry about the exact name for the page after we've got a better idea of exactly what it will contain? WhatamIdoing (talk) 21:24, 31 May 2008 (UTC)
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- I say we make a new page just for observation in medicine and just leave watchful waiting as its own.
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[edit] Uses
Preliminary to adding content to the article, it may help to identify here the medical contexts in which these terms are most commonly used. --Una Smith (talk) 20:40, 28 May 2008 (UTC)
- expectant management: very common in pregnancy
- watch and wait, watchful waiting: common in cancer (esp post-treatment management), ear infections in children, umbilical hernias in infants
- active surveillance: very common in prostate cancer and other conditions relating to the prostate gland
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- Actually we hardly ever observe children with ear infections.
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- And if there is a operation on a person, they will either be admitted and then have the surgery or they will be admitted under the surgical observation unit for post op fever or for consults for medical management, but the policy is different everywhere.--Teledoc12 (talk) 04:30, 30 May 2008 (UTC)
[edit] Please
Could we please leave the page in the same place for, say, the next couple of days? Surely it's not really, really important to move it several times in the same week. WhatamIdoing (talk) 16:26, 30 May 2008 (UTC)
