Table 2 Clinicians’ identified top ten problems leading to delayed diagnosis in primary carea
Rank | Problems leading to delayed diagnosis in primary care | Total priority score | Type of factor leading to diagnostic error | Breakdown points in the diagnostic process |
|---|---|---|---|---|
1 | Poor communication between secondary and primary care; e.g. investigations that are ordered by secondary care are not visible in primary care | 78.2 | System factor | Referral & consultation |
=1 | Inverse care law i.e. those who most need medical care are least likely to receive it. Conversely, those with least need of health care tend to use health services more and more effectively | 78.2 | System and patient-related factor | Access & presentation |
3 | Patients attending other services such as A&E walk-in centres instead of seeing their own GP | 76.6 | System and patient-related factor | Access & presentation |
4 | Multiple symptoms or co-morbidities masking the real problem | 76.3 | Cognitive factor | Patient-practitioner encounter |
5 | Lack of continuity of care - seeing different GPs’ for the same problem and never being able to follow ‘a case’ through properly | 76.3 | System factor | Patient-practitioner encounter |
6 | Time constraints such as the 10 min consultations that lead to incomplete history-taking and patient examination | 76.3 | System factor | Patient-practitioner encounter |
7 | Lack of patient awareness of ‘red flag’ symptoms | 76 | Patient-related factor | Access & presentation |
8 | Patient’s delay in presenting symptoms (e.g. “I have had blood in my urine for a year”) | 75.4 | Patient-related factor | Access & presentation |
9 | Psychiatric co-morbidity (the co-occurrence of two or more psychiatric diagnoses) leading doctors to insufficient attention to physical symptoms | 74.5 | Cognitive factor | Patient-practitioner encounter |
10 | Language and cultural barriers between the GP and the patient | 73 | System and patient-related factor | Patient-practitioner encounter |