Traditional clinical teaching tells us to treat the patient, not the number.
At face value, you could interpret this old teaching as “only treat if there are symptoms”. When applying this teaching, we should include some nuance, namely see how the number fits into the big picture.
Good examples include abnormalities in asymptomatic patients that may not be causing a problem right now, but have consequences in the future. Such abnormalities could include:
Elevated Hemoglobin A1c
Decreased glomerular filtration rate
Elevated blood pressure
In an asymptomatic patient, these types of measures are analogous to someone walking towards a cliff’s edge. They are not falling yet. However, the closer they get to the edge the more at risk they are of falling.
When you take the big picture into account, you understand “the number” in the context of the overall, clinical situation. So what is this big picture then? The big picture includes information from the history, physical exam, test results, response to treatment, etc. These are like pieces of a puzzle that fit together to make the big picture
Without this greater context, ”the number” can have many different meanings, and can lead you down many, different paths.
You can certainly treat “the number”, but you should do so as part of the big picture that is the patient.
If you are interested in this and further topics regarding clinical decision making, please check out my book: A Guide to Clinical Decision Making
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