Family Medicine: Incidentalists for Incidentalomas

"You have an incidentaloma (an incidental finding on a medical evaluation such as a lab test or imaging study)", I tell my patient.  "I'm referring you to our Incidentalist, a new specialty started to evaluate and treat incidentalomas."

We know that CT scans of the chest will reveal pulmonary nodules on 36% of so people.  These incidental findings are currently evaluated by CT scans at regular intervals to follow the nodule.  One and one half percent of the patients will have a problem that requires further treatment.  Most would eventually be found by other evaluation strategies.  The incidentalist will save lots of money by accurately interpreting the probabilities and finding a more cost effective strategy for the patient to get reassured or evaluated.  The 27,000 yearly cancers that we apparently generate each year from the radiation used in imaging studies are a testimony to our need for a different strategy to pursue these incidental findings.  The money saved by avoiding unnecessary testing strategies will pay for the Incidentalist and their training.

There are many other incidentalomas on laboratory test results and other imaging studies and others beyond the scope of this article.  

The new specialty will fit perfectly with the Accountable Care Organization (ACO) concept.  The Patient Centered Medical Home will include the Incidentalist, along with the Family Physician, Family Nurse Practitioner, Social Worker, Holistic Practitioner and Care Coordinator.  The Incidentalist will typically wear a headset and have four monitor screens in their workspace.  They will be an information maven, celebrating the confluence of people and numbers.  Doctors and patients will love them.

The Incidentalist is coming to a doctors office near you.  If they work out in primary care, hospitals will be the next site for implementing the hospital based Incidentalist.