The role of the doctor and the medical system in the diagnostic delay in pediatric malignancies.
OBJECTIVE
We evaluated the roles of the doctor and the medical system in Israel in the diagnostic delay of childhood malignancies.


METHODS
We investigated the factors affecting the delay in the diagnosis of childhood malignancies in 315 children with solid malignancies, diagnosed and treated in Rambam Medical Center (RMC), between 1993 and 2001. Those factors were divided into two groups: 'Healthcare-system-related parameters', (factors directly related to the medical system), and 'Patient-related parameters' (factors that are not part of the medical system, but directly affect medical judgment and decisions, including factors related to the tumor). We also took into consideration epidemiological, social, and medical issues.


RESULTS
The main 'Healthcare-system-related parameters', which were found to influence the delay in diagnosis, were the type of medical authority that was initially consulted; the specialty of the first doctor; the number of additional doctors whom the child had visited, and the number of times the child had visited the first doctor. The main 'Patient-related parameters' found to have an impact on the delay in diagnosis were the age of the child, the tumor type, and the presenting symptom.


CONCLUSIONS
The education and awareness of doctors at the primary healthcare clinics must be improved. We suggest ways of improving the approach of doctors and managing a child with a suspected malignancy.
Haimi
Motti
M
Children's Health Center, Armon Tower, Clalit Health Services, Haifa, Israel. mottiha@clalit.org.il
Perez-Nahum
Monique
M
Stein
Nili
N
Ben Arush
Myriam Weyl
MW
D002648:Child; D002675:Child, Preschool; D003695:Delivery of Health Care; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009369:Neoplasms / Q000175:diagnosis*; D010819:Physician's Role; D012017:Referral and Consultation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors