Page 78 - Diagnostic delay of endometriosis
P. 78

Many of the participating GPs routinely prescribed the contraceptive pill in a cyclic manner instead of continuously. They were not aware of the possibility of organ damage like infertility or chronic pain syndromes resulting from late diagnosis and treatment, nor the advice to fully suppress menstruation by hormonal therapy in case of endometriosis.
“GP1: But if you think of it and you start the pill you aren’t doing anything wrong. GP8: Well they will have menstruations even on the pill, but would it be better to take it continuously rather than the usual way? I actually don’t know about that. Should you advise women with endometriosis to take the pill continuously? GP3: I don’t know for sure...”[FG1, GP1, male; GP3, female, postgraduate training; GP8, male]
Patient characteristics
It appeared that several patient characteristics influenced clinical strategies. GPs were more reluctant in referring patients with dysmenorrhoea as compared to patients with infertility. The GPs were more willing to refer to a gynaecologist if family planning came up during the consultation. The suggestion that timely diagnosis and treatment of endometriosis may prevent future infertility increased their sense of urgency. One GP suggested that a note with considerations about possible endometriosis in the patient’s file may be helpful as a reminder if the woman presents some years later with persisting complaints or desire for pregnancy.
Women who frequently visit the GP’s office with a wide spectrum of complaints and who perceive a high burden of those complaints were more often considered as somatizing and less frequently referred.
The GPs were more willing to refer women who are assertive during the consultation as compared to more passive women. They were more likely to consider endometriosis in women who brought information they found on the internet to the consultation. GPs considered additional diagnostic testing or referral if their own treatment strategy was not successful. However, they noticed that many women do not return to their office when symptoms persist, which makes it more difficult to identify those with treatment failure.
“There was this lady who had a wide range of complaints, very diffuse. And to be honest, she came up with the diagnosis [endometriosis] herself. Actually, I didn’t much agree with her. But then the gynaecologist did a laparoscopy and it appeared to be endometriosis after all.”[FG2, GP2, male]
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