title: Perspectives of primary health care physicians on diagnosing and referring patients with apparent osteolytic lesions on plain X-ray films: a cross-sectional study.
abstract: OBJECTIVE
  The identification and diagnosis of musculoskeletal symptoms are major challenges for primary care physicians. A lack of clinical suspicion, limited exposure, and referral of patients to nonspecialized centers can delay the management of cases, which in turn can increase morbidity and mortality.
  
  
  METHODS
  Four different sets of X-ray films were shown to 91 primary health care physicians. The first two were normal, whereas the third and fourth showed bone lesions. Participants were asked to indicate the presence of an abnormality, the diagnosis, and the approach to referral if required.
  
  
  RESULTS
  There was a variation in the results for the first two sets of normal X-ray films. Most participants (73.6%) were able to diagnose the first case correctly. However, 73.6% of participants were unable to diagnose the second case correctly. A high percentage of participants (90.1%) were able to detect abnormalities in Cases 3 and 4, with nearly all participants indicating that they would refer patients to centers other than bone oncology centers in the western region of Saudi Arabia if they suspected bone tumors. Only 25.8% of participants were aware of these bone oncology centers.
  
  
  CONCLUSIONS
  Physicians in many primary health care centers need practice in reading normal X-ray films to avoid unnecessary referral of patients to specialized medical centers. We recommend the development of a new system for referring patients suspected to have bone tumors to avoid a delay in the management of cases and to decrease morbidity and mortality.
authors.affiliation: King Abdullah International Medical Research Center, Jeddah, Saudi Arabia; Department of Orthopaedic Surgery, College of Medicine, King Saud Bin Abdul-Aziz University for Health Science, Jeddah, Saudi Arabia.
authors.forename: Ali
authors.initials: A
authors.lastname: Alyami
authors.affiliation: King Abdullah International Medical Research Center, Jeddah, Saudi Arabia; Department of Orthopaedic Surgery, Umm Alqura University, Makkah, Saudi Arabia.
authors.forename: Yasser
authors.initials: Y
authors.lastname: Alshomrani
authors.affiliation: King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.
authors.forename: Rayyan
authors.initials: R
authors.lastname: Suqaty
authors.affiliation: King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.
authors.forename: Shaddy
authors.initials: S
authors.lastname: Futtiny
authors.affiliation: King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.
authors.forename: Faisal
authors.initials: F
authors.lastname: Alnaqib
authors.affiliation: King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.
authors.forename: Muath
authors.initials: M
authors.lastname: Albarakati
authors.affiliation: King Abdullah International Medical Research Center, Jeddah, Saudi Arabia; Department of Surgery, Faculty of Medicine, Umm Alqura University, Makkah, Saudi Arabia.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Alhazmi
keywords: X-ray film; diagnosis; lesion; osteolytic; primary health care physicians; referral