7 min read
Filed by: Tenisha Manning, Founder – CW Alliance
What's happening:
Your test comes back abnormal. An irregular heartbeat. An unexpected shadow on imaging. An odd result in bloodwork. The provider orders more tests to investigate. You go for additional testing. But the original abnormality is never explained. Never discussed. Never followed up. Instead, it's labeled "incidental"—a finding that appeared incidentally and therefore doesn't need investigation.
Why it matters:
An abnormal finding is not incidental. It is data. It is evidence of something happening in your body that differs from normal. The word "incidental" has become a way to dismiss findings that don't fit into the provider's current diagnosis, that require investigation the provider doesn't want to pursue, or that contradict the reassurance the provider has already given. The word "incidental" has become permission to ignore. And ignored findings have consequences.
What to do differently:
When an abnormal finding appears, demand explanation. What does it mean? What causes it? What is the plan to investigate it? Don't accept "incidental" as an answer. Demand follow-up. Get a second opinion. Document the finding and the provider's refusal to investigate. Insist that every abnormality receives explanation and, if necessary, investigation. Incidental findings are not benign because they appear incidentally. They are abnormal because the test showed them.
You have an EKG. The EKG is abnormal. The provider shows you the result. "It's abnormal," they say. Then they order blood tests. To check for a heart attack. To rule out the serious possibility.
The blood tests come back normal.
The provider tells you the EKG abnormality is "incidental." It doesn't matter. You can go home. Take it easy. Don't worry about it.
But you research. You find out what the abnormality might indicate. You find studies. You find case reports. You find that the pattern on your EKG is associated with serious cardiac conditions that require monitoring, investigation, or treatment.
You call back. You ask about the abnormality. You ask what the plan is.
The provider says: "It's incidental. Most people have some EKG abnormality. It's not significant."
You are not reassured. Your body told you something was wrong. The test confirmed it. The provider dismissed it with a word: incidental.
The signal: An abnormality appeared. It was investigated briefly. It was not explained. It was labeled incidental and dismissed. You left without understanding what it means or what happens next.
What happens when abnormal findings are dismissed as incidental:
A test is ordered. The test returns abnormal. The provider reviews the result. The provider makes a clinical judgment: "This abnormality is not related to the patient's current complaint. It is incidental. It does not require follow-up."
The provider documents this judgment. The abnormality is noted in the chart. But no investigation is pursued. No explanation is given. No plan is created.
The word "incidental" becomes a label that absolves the provider of responsibility. It becomes permission to move on. It becomes an answer to the unasked question: "Should we investigate this?"
But abnormal findings that are not investigated do not disappear. They exist in the patient's chart. They exist in the patient's body. And they exist unexamined and unexplained.
The pattern across cases:
When abnormal findings are dismissed as incidental:
The provider acknowledges the abnormality exists
The provider makes a judgment that it is unrelated to current symptoms
No investigation is pursued
No explanation is given to the patient
No follow-up plan is created
The patient is left confused and uncertain
Later, if the abnormality becomes clinically significant, the provider can point to the fact that it "was documented" and "was known"
But because it was dismissed as incidental, it was never properly investigated
The word "incidental" allows providers to document findings while avoiding responsibility for investigating them.
Ezekiel 33:6 teaches: "But if the watchman sees the sword coming and does not blow the trumpet to warn the people and the sword comes and takes the life of one of them, that man will be taken because of his sin, but I will hold the watchman accountable for his blood." The watchman who sees a warning signal and dismisses it bears responsibility for what follows. An abnormal finding is a warning signal. To see it and label it incidental—to dismiss it without investigation—is a failure of the watchman's duty.
William Osler observed: "Listen to your patient; he is telling you the diagnosis." A patient's body is also telling a diagnosis. An abnormal test is the body speaking. To dismiss that voice as incidental is to stop listening.
Research on diagnostic errors shows that missed diagnosis frequently involves abnormal findings that were documented but not investigated. One documented case illustrates this pattern: A 37-year-old woman presented to the hospital with cardiac symptoms. Her presentation included classic warning signs—symptoms that should have triggered cardiac investigation. However, the provider attributed her symptoms to "working mom anxiety." The abnormal EKG findings that accompanied her presentation were documented but not investigated as potentially cardiac in origin. The provider's dismissal of the findings, combined with misattribution of her symptoms, resulted in delayed diagnosis. The woman suffered a heart attack and subsequent brain damage. The case demonstrates how abnormal findings can be documented, dismissed as unrelated to the patient's apparent condition, and left uninvestigated—with devastating consequences when the findings prove clinically significant.
Research on incidental findings in medical imaging shows that the term "incidental" creates a paradox: the finding is significant enough to document, but the word "incidental" makes it seem insignificant. Studies of follow-up on incidental findings show that many abnormalities that are labeled incidental are never investigated, are never explained to the patient, and are lost to follow-up—despite being documented in the medical record. When these findings later become clinically relevant, the documentation that "was there" provides no protection if it was never investigated or explained.
The label "incidental" has become a way to acknowledge a finding while avoiding responsibility for understanding it.
Why Abnormal Findings Are Dismissed As Incidental
Let me explain what's happening structurally.
The provider's cognitive framework creates the dismissal.
A provider orders a test for a specific reason: to investigate a particular symptom or suspected condition. The test returns. If the test result supports the provider's hypothesis about the current complaint, the provider pursues it. If the test result shows something unexpected—something unrelated to the current complaint—the provider's brain categorizes it as "incidental."
The word "incidental" is a cognitive shortcut. It allows the provider to acknowledge that the abnormality exists without having to figure out what it means or what to do about it.
The system has no mechanism for investigating unrelated findings.
A provider is paid for managing a patient's current complaint. They are not paid for investigating unexpected findings that appear on tests ordered for other reasons. The system incentivizes resolution of the presenting problem, not investigation of incidental findings.
Additionally, investigation of incidental findings requires time, additional testing, specialist consultation, and documentation. It creates more work. In a system where providers are overworked and reimbursement is tied to volume, investigating incidental findings feels like a luxury they cannot afford.
The provider assumes the patient won't worry about it.
Providers often assume that if they don't mention an incidental finding, or if they minimize it, the patient won't worry. They believe they are protecting the patient from unnecessary anxiety. But this assumption treats the patient as someone who should be shielded from information about their own body—rather than as someone who deserves complete information.
Good providers understand that incidental doesn't mean insignificant.
A truly competent provider recognizes: "An abnormal finding is abnormal, whether it is related to the current complaint or not. I have a responsibility to investigate it, explain it, or create a plan for follow-up." They don't use the word "incidental" as permission to ignore. They use it as a flag that requires attention.
But many providers—even good ones, working within a system that discourages additional investigation—label findings as incidental and move on. And when those findings later prove significant, the damage has been done.
This is a system design problem. But it costs you health.
CLUE™ is how you recognize when an abnormal finding is being dismissed and how you demand investigation.
The signal appears when a provider shows you an abnormal test result and then says it's "incidental" and doesn't require follow-up.
You'll recognize it by:
Provider orders a test
Test returns abnormal
Provider briefly acknowledges the abnormality
Provider then says it's "incidental" or "not significant"
No explanation is given for what the abnormality means
No plan is created for investigation or follow-up
You leave the appointment confused about what the abnormality is and whether it matters
Provider's tone suggests you shouldn't worry about it
When you ask questions, provider reassures you without answering the question
Provider documents the finding but takes no action
A dismissing provider says: "It's incidental. Don't worry about it."
A responsible provider says: "This abnormality appeared. Here's what it might mean. Here's the plan to investigate it further. Here's what we'll monitor."
The difference is investigation.
Across your medical visits:
The pattern of dismissed findings means:
Abnormal results are acknowledged but not explained
No investigation is pursued
No follow-up plan is created
You leave without understanding
The finding sits in your chart, uninvestigated
The pattern of investigated findings means:
Abnormal results are explained
Investigation is pursued (or a clear reason is given for why it's not)
Follow-up plan is documented
You understand what it means and what happens next
A baseline is established for future comparison
The pattern reveals whether abnormal findings are being investigated or dismissed.
The word "incidental" has become medical permission to ignore. Providers use it as a way to acknowledge a finding while avoiding responsibility for investigating it.
But incidental does not mean benign. Incidental does not mean unimportant. Incidental means the finding appeared incidentally—not because you were being screened for it, but because it showed up on a test ordered for another reason.
That does not make it less real. It does not make it less significant. It makes it unexpected. And unexpected findings require investigation, not dismissal.
Women who maintain their health understand this early:
An abnormal finding is not incidental. It is data. It is evidence. It deserves investigation and explanation.
They don't accept the word "incidental" as a substitute for explanation. When an abnormality appears, they ask:
What does this abnormality mean?
What causes it?
Does it require investigation?
What is the plan?
They document the provider's response. They get second opinions. They insist on explanation. They refuse to leave an abnormality uninvestigated.
This understanding is embedded in the USU framework: Every abnormality deserves explanation. Every finding deserves investigation. You are entitled to understand what your tests show and what your provider plans to do about it.
A provider can be competent, experienced, and well-intentioned and still dismiss an abnormal finding as incidental. The system encourages it. The word "incidental" makes it sound reasonable. The cognitive framework allows it.
But dismissal without investigation is not care. It is avoidance.
Here's what matters: When a test shows an abnormality, that abnormality deserves explanation. Not reassurance that it's probably fine. Not dismissal as incidental. Explanation. Investigation. A plan. Even if the investigation concludes that the abnormality requires no treatment, the investigation itself—the explanation, the understanding, the documented plan—is part of good care.
Providers who understand this order follow-up testing. They consult specialists. They create documentation of the investigation they pursued. They explain to the patient what was found and why no further action is needed—if that is indeed the case.
But many providers, facing time pressure and system incentives, label findings as incidental and move on. And when those findings later matter, the damage compounds.
You deserve better. You deserve investigation. You deserve explanation. You deserve to understand what your body is telling you—and what your tests are showing.
A critical test has been ordered. Follow-up is needed. But no timeline is set. No specific plan is defined. You're told to return "as needed" or "if symptoms change." You're left without clarity on whether the provider will call you with results. Whether you should check the portal. Whether follow-up is actually happening or whether it's been forgotten.
Issue #21 examines watch-and-wait without a defined plan. The difference between appropriate monitoring and dangerous drift.
Stay aware. Stay ready. Stay impossible to dismiss.
— USU
Next week: Issue #21
Watch-and-wait without a defined follow-up plan. The test is ordered. But when do you come back? Will the provider call? Should you check the portal? The drift begins when the plan is unclear.
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P.S. An abnormal finding is not incidental. It is your body speaking. Demand that someone listens.
Weekly investigative health intel from the Unusual Symptom Unit. This dispatch series examines the thirty patterns between unusual symptoms and medical dismissal. The podcast—launching Summer 2026—will investigate the cases, the women, and the solutions.
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