Page 91 - Diagnostic delay of endometriosis

Introduction
Diagnostic delay in endometriosis remains a problematic issue. The time from onset of symptoms to diagnosis is reported to take up to 12 years.1-4 The cause of this diagnostic delay is multifactorial. A wide variety of clinical symptoms, combined with the lack of an accurate non-invasive diagnostic test imposes difficulties for clinicians. In general, diagnostic delay is longer for women who first experience symptoms at a young age and relatively short for those who present with subfertility.1, 5 Women with chronic pelvic pain and an eventual diagnosis of endometriosis get the largest number of other diagnoses rather than endometriosis and have the highest rates of referrals compared with other causes of chronic pelvic pain.6 A study from the United States demonstrated that 23.5% of the participants visited more than four physicians before they were eventually diagnosed with endometriosis.7 Not surprisingly, the time between first seeking medical care and diagnosis increased with the number of physicians seen.
The variability in reported diagnostic delay between different study populations throughout the world suggests that factors related to healthcare organisation may also be involved. Accessibility to medical specialists varies and is commonly regulated by the government. In general, countries with government-funded health care show a stronger position and gate-keeper role for General Practitioners (GPs), whereas medical specialists in countries with insurance-funded health care are often freely accessible.8-10 Countries with a government-funded health care and a strong gate-keeper profile for GPs like the United Kingdom, Spain and Italy show a diagnostic delay of 8 to 10 years.4 Interestingly, in countries with insurance-funded health care and free accessibility to medical specialists, like Germany and Austria, a diagnostic delay of 10.4 years has been reported.3 Diagnostic delay of endometriosis in The Netherlands is reported as 7.4 years.11 The Dutch health care system is insurance-funded, but is characterised by a strong position of the General Practitioner. A referral from the General Practitioner is mandated for reimbursement of health care costs by the insurance companies, and free access to medical specialists is therefore limited.
Awareness of endometriosis amongst GPs is of major importance to ensure timely referral to the correct medical specialist.12 However, as diagnostic delay appears equally long in countries where patients present their symptoms to a medical specialist directly, it seems delays occur at the gynaecologists’
Gynaecologists’ view on diagnostic delay and care performance | 89