Watchful waiting (also watch and wait or WAW) is an approach to a medical problem in which time is allowed to pass before medical intervention or therapy is used. During this time, repeated testing may be performed.
Related terms include expectant management,[1][2]active surveillance (especially active surveillance of prostate cancer),[3] and masterly inactivity.[4] The term masterly inactivity is also used in nonmedical contexts.[5]
A distinction can be drawn between watchful waiting and medical observation,[6] but some sources equate the terms.[7][8] Usually, watchful waiting is an outpatient process and may have a duration of months or years. In contrast, medical observation is usually an inpatient process, often involving frequent or even continuous monitoring and may have a duration of hours or days.
Medical uses
Often watchful waiting is recommended in situations with a high likelihood of self-resolution if there is high uncertainty concerning the diagnosis, and the risks of intervention or therapy may outweigh the benefits.
Watchful waiting is often recommended for many common illnesses such as ear infections in children;[9] because the majority of cases resolve spontaneously, antibiotics will often be prescribed only after several days of symptoms. It is also a strategy frequently used in surgery prior to a possible operation,[10] when it is possible for a symptom (for example abdominal pain) to either improve naturally or become worse.
In many applications, a key component of watchful waiting is the use of an explicit decision tree or other protocol to ensure a timely transition from watchful waiting to another form of management, as needed.[15] This is particularly common in the post-surgical management of cancer survivors, in whom cancer recurrence is a significant concern.
Medical observation
Usually, patients in observation, according to hospital policy, are kept in observation for only 24 or 48 hours before they will be discharged or admitted as an inpatient. Insurance can play a role in how "observation" is defined (for example, US Medicare does not support observation services for over 48 hours).[16]
^Pestana, Carlos (7 April 2020). Pestana's Surgery Notes (Fifth ed.). Kaplan Test Prep. pp. 6–7. ISBN978-1506254340. Signs of a fracture affecting the base of the skull include raccoon eyes, rhinorrhea, and otorrhea or ecchymosis behind the ear. Expectant management is the rule. From our perspective, the significance of a base of the skull fracture is that it indicates that the patient sustained very severe head trauma
^Katz DA, Littenberg B, Cronenwett JL (November 1992). "Management of small abdominal aortic aneurysms. Early surgery vs watchful waiting". JAMA. 268 (19): 2678–86. doi:10.1001/jama.268.19.2678. PMID1433687.
