Tuesday, April 12, 2011

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.


11 comments:

  1. I should make it clear that there is no such specialty as Incidentalist. Physicians currently have adequate training as information masters, but often move away from their skills for business, specialty or legal issues. This is a wake up post for our profession. Dr S

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  3. This is where a "like" button would be great! :)

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  4. Wonderful, Now we need a TV series to put this issue into the group consciousness of our times

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  5. Unfortunately we have a tv show for this - It is called "House". All sorts of incidentalomas turn out to have life treatening outcomes - the exact opposite of real life

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  6. Very well said...

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  7. Great post and I love the title of the new specialist, an "incidentalist." While humorous, the concept is right on, and someone should do this. Maybe me.

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  8. Thanks for all the comments. Kenny Lin, MD just sent off a post on incidentalomas, so it's a timely topic. WS, a like button is probably one of the gadgets I didn't add yet, but I'll look into it. LB/ Phil The TV show could go to the edge of Family Medicine so it doesn't conflict with House.
    Dr. CKK, you would be a whiz as an Incidentalist. We do need to have identified info mavens here and there and at the edge of FM.

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  9. Jason, thanks for the feedback. Maybe the OSMA can make room for incidentalists. apj

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    Please backlinks from this blog ...
    best wishes ... I hope the family around the world will always be healthy

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  11. my blog link : http://healthandcarebody.blogspot.com/

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