Do patients play a role in a missed diagnosis?

Whether you call them missed diagnoses or delays in seeking care, cancer cases that could have been caught earlier engender sharp regret, Dr. Pauline Chen writes in a New York Times column that asks how much responsibility doctors and patients bear.

For an answer she turns to Dr. Saul Weingart, vice-president of Quality Improvement and Patient Safety at the Dana-Farber Cancer Institute. In a study published in the June issue of The Journal of Internal Medicine, he and his Harvard colleagues write that both doctors and patients missed steps in 25 out of 100 cases where breast cancer was spotted at an advanced stage.

About half of those failures could be traced to something the patients didn't do: missed mammogram appointments or not going to specialists their primary care doctors referred them to, Weingart told Chen. When they looked more closely, Weingart said, the researchers found that these women were more likely to face barriers of language, transportation difficulties, and family obligations that made it harder for them to follow their doctors' advice.

Doctors should step in to help, Weingart says in Chen's column, while acknowledging that responsibility is shared between doctors and patients.

"Given that the patients who fall through the cracks are usually the least resourceful and most vulnerable, there is at least a moral obligation for clinicians and health care systems to provide a robust safety net for these patients," he says. "I think we physicians need to support patient responsibility, but we also need to get our own house in order first. ... After we get that figured out, we then need to think about ways to help our patients do what they need to do."