Improving medical diagnosis

Diagnostic process: Doctor, I don´t feel well

El Nido, Philippines Islands


I met my patient, a 65-years-old man with a diagnosis of colon cancer without residual tumor, and diabetes type 2. He was on his third day in the hospital after a diagnosis of pneumonia. I said to him:you are going home tomorrow, but he said to me : doctor I don´t feel well… Continue reading


Examples of missed opportunities for an earlier cancer diagnosis

Alpujarras, Granada, Spain

Some Situations prone to a missed diagnosis in cancer

Tumor Clinical situation
Lung cancer False negative X-ray: delays six times longer.

Superior sulcus tumours  treated for musculoskeletal shoulder pain.

Older and socially deprived groups




Larynx Performing mirror examination significantly shortened the professional diagnostic delay.

Women double probability of diagnostic delay

Upper gastrointestinal Taking acid suppression for symptoms delays the diagnosis
Gastrointestinal Inappropriate use of a rapid access to an endoscopy service
Cervix cancer Pregnancy: delayed diagnosis
Rectal cancer Negative barium enema within the year prior to diagnosis as a cause of the delayed diagnosis  





Diagnostic delay in cancer: why we can not solve the equation?

Amish territory

Diagnostic delay in cancer is a difficult subject to study with many confounder factors. Several papers have been published with controversial results about the relationship between delay and survival, although there is a clear tendence for a worse prognosis with longer delays. We will expose some of the confounder factors and biases that can interact with the association between  delay and survival.

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Diagnostic Excellence: from theory to practice

This is real good news. Putting Diagnostic Improvement in practice. I,m sure The Center will be a reference for all who are working in the field 0f clinical reasoning and improving diagnosis. Dr.Newman-Toker is a brilliant and clever communicator and an expert in the field of Diagnostic error. Congratulations.

Diagnostic delay and models of cancer care




There are three basic models of cancer care in the literature, two of them derived from the world of the psychology , the Safer model [23]  and  the Andersen model [24], widely used in publications, and the third one coming from the medical general practice world, the Olesen model [25] developed in Denmark.  Based on her publication we think is also worth to introduce a fourth model, the Walter model [26], a refinement of the Andersen model, that introduces the term “time interval” rather than delay.

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Case Analysis: a problem of perception

Havana,Cuba? No, Málaga, Spain

He was my patient. A serious and educated 55- year-old man with a diagnosis of metastatic colon cancer waiting to start chemotherapy. I started my usual physical examination, normal conjuntival coloration, normal heart sounds, but something keeps my attention: no ventilation in the left basal lung. No signs of pleural effusion or atelectasia. No dyspnea or thoracic pain. I asked for a thoracic X-ray but nothing attracts my attention.

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How can we define delay in cancer?

Clary St., Boston, by Lourdes Alonso

The time between symptom recognition and a definitive diagnosis have been described in many terms including ‘Time-to-Diagnosis’ (TtD), delay to diagnosis, pre-diagnostic interval and duration of symptoms in the literature [6] and we will use TtD across this paper. The concept of the term “delay” assumes that there is an ideal period of time to arrive to a diagnosis in a patient with cancer

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