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Friday, January 31, 2014

What to Do About ‘Incidental’ Medical Findings?


How should clinicians address “incidental” medical findings that might surface when they are investigating a seemingly unrelated clinical issue? A federal panel has weighed in, offering recommendations in a new report, “Anticipate and Communicate,” released in December.

 “Incidental findings — traditionally defined as results that arise that outside the original purpose for which the test or procedure was conducted — can create a range of practical, legal, and ethical challenges for recipients and practitioners,” wrote the authors of the report by the Presidential Commission for the Study of Bioethical Issues. “Discovering an incidental finding can be lifesaving, but it also can lead to uncertainty and distress without any corresponding improvement in health or wellbeing.”

The recommendations of the Commission — an independent panel of experts that advises the President and his administration on bioethical issues, which address clinical practice, research studies, and direct-to-consumer testing — are meant to educate physicians, patients, researchers, policymakers, professional organizations, and health-related businesses.



The panel recommended, among other suggestions, that clinicians inform patients before a test or procedure is ordered about the range of possibilities that might be revealed.

“Practitioners should inform potential recipients about their plan for disclosing and managing incidental and secondary findings, including what findings will and will not be returned,” said the authors of the report.

In another recommendation, the panel advised that clinicians “should respect a patient’s preference not to know about incidental or secondary findings to the extent consistent with the clinician’s fiduciary duty.” If doctors aren’t comfortable with the patient’s wishes regarding the degree to which they want to know testing results, they could choose not to order the test or refer the patient to another practitioner.

In an article published Dec.13 in Science, the commission’s chair, Amy Gutmann, PhD, president of the University of Pennsylvania, stressed the importance of shared decision-making between doctors and their patients.

“Clinicians live up to their highest calling when they discuss how they will handle incidental finings with their patients,” she wrote.

James L. Bernat, MD — Louis and Ruth Frank professor of neuroscience and professor of neurology and medicine at the Geisel School of Medicine at Dartmouth — told Neurology Today that he found the report to be “very comprehensive and well thought out.” He said the report’s title reflects the overriding take-away message for clinicians when it comes to dealing with incidental findings — to anticipate and communicate.

“No one can anticipate everything,” he said. “But physicians and patients should recognize that when a test is done for one reason that it is possible that other unanticipated findings will be made,” said Dr. Bernat, who serves on the editorial advisory board of Neurology Today and has authored the publication’s “Ask the Neuroethicist” column. [Read Dr. Bernat’s response to a similar question about incidental medical findings in a previous issue of NT:]

Look for the full discussion of the panel’s recommendations, as well as their implications for researchers and patients, in the Feb. 6 issue of Neurology Today. For now, see our collection of articles on ethical issues in neurology: