Predict–Treat–Reassess

A Safe Therapeutic Algorithm

Start with the Standard Reassess at a Defined Time Escalate Logically
Reminder

When you see a disease — start with the standard.

Do Start with the standard (horse) · Know when it may fail · Reassess properly · Escalate logically.
Do not Jump to rare diseases immediately · Continue ineffective treatment blindly · Panic and change drugs randomly.
The goal Not emotional medicine. Not defensive medicine. Structured medicine.

Why this model exists In many common diseases…

The reality of treatment

There is a standard first-line treatment.
Most patients respond to it.
Some patients will not respond.
Early detection of failure changes outcome.

Therefore we need

A defined starting point — the horse treatment.
A structured reassessment at a fixed time.
A logical decision tree based on response.
A framework that prevents random escalation.
The Model

Four Steps — applied to every patient, every disease

1
Predict

Predict Risk of Treatment Failure

Before starting therapy, ask: are there red flags suggesting standard treatment may fail? Not every patient is identical. Identifying risk factors early changes your monitoring plan — and sometimes your treatment plan.

Ask yourself Are there features that predict poor response to standard therapy?
No red flags Start standard therapy. Monitor routinely.
Risk factors present Risk-stratify. Monitor closely. Consider modifying early.
2
Treat

Start Standard (Horse) Treatment

Give the established first-line therapy. The standard exists because it works for most patients — and deviating from it without reason introduces risk without benefit.

Not
  • Exotic combinations not yet indicated
  • Unnecessary second-line drugs
  • Experimental ideas based on a hunch
3
Reassess

Reassess at a Defined Time Point

This is the most critical step. Every disease has a predefined assessment time. Never treat indefinitely without reassessment — this is how failures are missed and complications are created.

Ask at the defined time point
  • Has the patient improved clinically?
  • Are objective markers (labs, imaging) improving?
  • Is the disease progressing despite treatment?
4
Decide

Decide Based on Response

The reassessment result drives the next decision. This is not guessing — it is structured, evidence-based escalation.

Response achieved Continue current therapy or move to the next protocol phase.
No response — investigate before escalating
  • Wrong diagnosis?
  • Poor compliance?
  • Drug resistance?
  • Complication developed?
  • True treatment failure?
Examples

Clinical Applications — the same architecture, different diseases

Predict Check for red flags before starting.
Treat Start steroids — standard first-line.
Reassess At defined time point per protocol.
Decide Remission → continue. No remission → evaluate.
Red flags — check before starting steroids
  • Persistent hypertension
  • Low complement (C3/C4)
  • Gross haematuria
  • Very young (< 1 year) or older age (> 12 years)
CTAC Most childhood nephrotic syndrome = minimal change disease. If no red flags → steroids without biopsy is safe and correct. Biopsy is reserved for atypical features or steroid resistance.
Remission achieved Continue steroid protocol as per guidelines. Taper according to response.
No remission — steroid resistant Further evaluation required. Consider renal biopsy and referral.
Predict Risk-stratify: standard vs. high-risk ALL.
Treat Induction → Consolidation → Maintenance.
Reassess Early response after induction is critical.
Decide Good response → continue. Poor → intensify.
Key principle Not all ALL is the same. Response to induction therapy is one of the most important prognostic factors. Early response assessment — not just diagnosis — guides the intensity of subsequent treatment.
Good early response Continue standard protocol through consolidation and maintenance phases.
Poor early response Intensify treatment. Consider high-risk protocol. Reassess for transplant eligibility.
Predict Assess for drug resistance risk before starting.
Treat Standard multi-drug regimen (HRZE).
Reassess 2-month sputum smear / culture conversion.
Decide Converting → continue. Not converting → investigate.
Risk factors for drug resistance — assess before starting
  • Previous TB treatment (especially incomplete)
  • Known contact with drug-resistant TB
  • Immunocompromised (HIV, transplant, steroids)
  • Local high-resistance prevalence pattern
Improving — sputum converting Continue standard regimen to completion. Do not add drugs without reason.
Not improving — investigate first Check compliance → rule out drug resistance → assess for complications. Do not randomly add drugs.
The universal point The Predict–Treat–Reassess structure applies across medicine. What changes is the disease, the drug, and the reassessment time point. The architecture is always the same.
Pneumonia Reassess at 48–72 hours. Improving → continue. Not improving → change or broaden.
Asthma Assess response after bronchodilator/steroid. PEFR or SpO₂ improvement guides next step.
Sepsis Reassess perfusion and haemodynamic response within 1 hour.
Hypertension Review blood pressure control after defined weeks before adding or changing agents.
✔

Accountability

Every treatment decision has a planned reassessment point.

⏱

Timed Reassessment

Not "wait and see" — a defined time point with a defined question.

📈

Evidence-based Escalation

Escalation is driven by response data, not anxiety.

⚖

Clinical Discipline

Structure prevents both under-treatment and over-treatment.

Common House Officer Mistakes This Prevents

What this model protects against

Changing antibiotics daily without objective reason
Continuing ineffective treatment beyond the defined period
Escalating treatment without reassessment
Missing treatment resistance by not investigating non-response
Universal Algorithm

The same five steps — every disease, every patient

1
DiagnoseCommon condition first (CTAC)
2
PredictIdentify risk factors for treatment failure
3
TreatStart standard treatment
4
ReassessAt the defined time point
5
DecideContinue or escalate logically
Final Message to Students
"Medicine is not guessing.
Predict. Treat. Reassess. Decide."

Master what is inside the box first.
Only then think outside the box.

Structured thinking Safe escalation Clinical discipline
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