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Action Threshold Conditions The action threshold conditions in these two instances reflect how confident the physician is about the diagnosis before recommending treatment. The confidence level needed to be high in the cancer situation, and moderate in the pneumonia case. In the daily practice of a clinician, making a diagnosis is “playing the odds.” Some patients are treated with medication or surgery for a particular illness that they do not actually have, while some patients with an illness are not treated at all. This happens because of the inherent qualities of the patient and the variety of manifestations of an illness. A common example is appendicitis. Some children with severe belly pain at the right lower side are sometimes operated on for acute appendicitis; when actually, the appendix is normal. On the other hand, some who are not operated on actually have appendicitis about to rupture a few days later, causing complications. Many children are treated for recurrent bronchitis or pneumonia, when in fact their basic problem is asthma. Since the treatment of bronchitis or pneumonia is relatively safe, clinicians quickly prescribe it. Another example is frequent and prolonged colds or a viral infection. Many children are diagnosed to suffer from frequent or prolonged colds, when actually they have allergies to begin with. In summary: If the likelihood of an illness is low, or to the left of the AT (Action Threshold), the clinician should not treat in most instances. If the likelihood of an illness is high, or to the right of AT, the clinician is betting that the treatment is reasonable even without a test if the target illness is not serious. If a test or imaging could change a clinician’s diagnostic confidence from either side of the AT, it has high diagnostic value, and therefore, must be requested. If a test or imaging would not change a clinician’s diagnostic confidence at all, then it should not be requested or even discussed. | go to top | parent's medical school | archives |
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