Category Archives: The Medical Work



Professional aspects  and details about the everyday practice and procedures, describing bedside manners in a proper way.

Improving medical practice: a utopia?

Article published by Professor Ximena Páez, professor at the Universidad de Los Andes de Venezuela. Co-author: Miguel Angel Díaz.

People in general  are not satisfied,unfortunately, with their health system. Why? The causes are multiple and complex. Could providers and patients individually and independently produce changes to achieve better medical practice? Could teaching and care institutions help in this target? Continue reading Improving medical practice: a utopia?

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.

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

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.

Continue reading Diagnostic delay and models of cancer care