This learning module describes how to minimize diagnostic delay.
Diagnostic delay in musculoskeletal tumors continues to occur despite widespread educational efforts and easy availability of diagnostic tests. Both patient and physician factors contribute to delay. Tumors and minor musculoskeletal ailments present in similar ways at first, hampering efforts at early diagnosis. Delay in diagnosis of cancer is the most common cause of medical malpractice in the USA.
Despite advances in our abilities to detect and treat these conditions, tumors of the musculoskeletal system continue to be missed, misdiagnosed, or mismanaged. This may be due to the overlap in presentation between tumors and more common musculoskeletal problems, or the rarity and confusing variety of tumors, or other factors.
Whatever the reason, the causes of diagnostic delay must be identified and minimized. Studies have shown that diagnostic delay is linked to both patient sociodemographic factors and physician factors. Sociodemographic risk factors for delay that have been identified include female sex, younger age, single or divorced marital status, and lower socioeconomic status.
Several physician factors have been identified that may contribute to delay:
1) The physician may ignore or fail to follow up on the patient's complaint.
2) The physician believed the patient was to young or appeared too healthy to have cancer.
3) The physician failed to provide follow-up or referral.
4) Physician relied too heavily on an apparently negative imaging study
5) The physician ignored risk factors
6) The physician failed to document the salient facts.
Delay in cancer diagnosis is the most common reason for malpractice litigation in the United States, as well as being the most costly allegation made against physicians.
