I would like to respond to the article in the May 2020 issue, “Sometimes we need to think of zebras: An observational study on delays in the identification of bone tumors in children” [BCMJ 2020:62(4):130-133]. Mr Dhinsa and colleagues are to be commended for this informative article highlighting some of the clinical challenges in diagnosing osteosarcoma or Ewing sarcoma in children. However, I take offence with the statement, “increased awareness could reduce delays.” Every patient I see as a family physician (not a general practitioner, which is not a term that should be used in a BCMJ article in 2020) may harbor a life-threatening illness. Is that chest pain unstable angina or a muscle strain? Is that difficulty swallowing reflux or an early esophageal cancer? Is that knee pain growing pains or cancer?
The patient journey illustrated diagnostic and treatment delays partly due to multiple visits to walk-in clinics, not necessarily a lack of awareness among family physicians. Was the patient’s family physician sent a copy of the patient’s visit after each walk-in clinic visit? Was it the same walk-in clinic that was visited? Was the patient advised to follow up with his or her family physician?
I, along with my family physician colleagues, fear missing significant diagnoses—especially in children. Awareness is important, but what is more critical is longitudinal care and communication between providers to ensure that each patient journey map brings the patient the care he or she needs in the most expeditious fashion possible.
—Tahmeena Ali, MD, CCFP, FCFP
This letter was submitted in response to “Sometimes we need to think of zebras: An observational study on delays in the identification of bone tumors in children.”
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