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Cited by 23Patient Safety and Medication ErrorsClinical Reasoning and Diagnostic SkillsHealthcare Systems and Technology

Peers without Fears? Barriers to Effective Communication among Primary Care Physicians and Oncologists about Diagnostic Delays in Cancer

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Lipitz-Snyderman, Allison, Kale, Minal, Robbins, Laura, Pfister, David, Fortier, Elizabeth, Pocus, Valerie, Chimonas, Susan, Weingart, Saul N·2017·BMJ Quality & Safety
DOI 10.1136/bmjqs-2016-006181PMC PMC5953211
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Abstract

Objective: Relatively little attention has been devoted to the role of communication between physicians as a mechanism for individual and organisational learning about diagnostic delays. This study’s objective was to elicit physicians’ perceptions about and experiences with communication among physicians regarding diagnostic delays in cancer. Design, setting, participants: Qualitative analysis based on seven focus groups. Fifty-one physicians affiliated with three New York-based academic medical centres participated, with six to nine subjects per group. We used content analysis to identify commonalities among primary care physicians and specialists (ie, medical and surgical oncologists). Primary outcome measure: Perceptions and experiences with physician-to-physician communication about delays in cancer diagnosis. Results: Our analysis identified five major themes: openness to communication, benefits of communication, fears about giving and receiving feedback, infrastructure barriers to communication and overcoming barriers to communication. Subjects valued communication about cancer diagnostic delays, but they had many concerns and fears about providing and receiving feedback in practice. Subjects expressed reluctance to communicate if there was insufficient information to attribute responsibility, if it would have no direct benefit or if it would jeopardise their existing relationships. They supported sensitive approaches to conveying information, as they feared eliciting or being subject to feelings of incompetence or shame. Subjects also cited organisational barriers. They offered suggestions that might facilitate communication about delays. Conclusions: Addressing the barriers to communication among physicians about diagnostic delays is needed to promote a culture of learning across specialties and institutions. Supporting open and honest discussions about diagnostic delays may help build safer health systems.

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  • When a specialist discovers an error, they often avoid reporting it to the original specialist or making referrals about it.

    “For example, when a specialist discovers an error, they often avoid reporting it to the original specialist or making referrals about it [254,255].”

    From Toward Safer Diagnoses: A SEIPS-Based Narrative Review of Diagnostic Errors (2026) · cites this paper as [255]

    In Results, under “Fears about giving and receiving feedback” (page unavailable), an oncologist says they have never given a referring physician negative feedback about a possible diagnostic delay or error. This supports reluctance to report errors to another physician, but the study concerns communication between oncologists and referring primary care physicians; it does not establish that specialists avoid making referrals about errors. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • Due to the fear of undermining professional relationships, specialists frequently do not report diagnostic errors.

    “Moreover, due to the fear of undermining professional relationships, specialists frequently do not report diagnostic errors.”

    From Toward Safer Diagnoses: A SEIPS-Based Narrative Review of Diagnostic Errors (2026) · cites this paper as [255]

    The Results section (“Fears about giving and receiving feedback”; page not provided) says specialists feared jeopardising professional relationships, and one specialist said they had never given referring physicians negative feedback about a possible diagnostic delay or error. The paper describes reluctance to communicate about delays, but does not establish that specialists frequently fail to report diagnostic errors. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

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Authors
Lipitz-Snyderman, A., Kale, M., Robbins, L., Pfister, D., Fortier, E., Pocus, V., Chimonas, S., & Weingart, S. N.
Affiliations
  • Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
  • Icahn School of Medicine at Mount Sinai (US)
  • Hospital for Special Surgery (US)
  • Memorial Sloan Kettering Cancer Center (US)
  • Tufts Medical Center (US)
ORCID
Venue
BMJ Quality & Safety
Publisher
BMJ
Published
2017-06-27
Volume
26
Issue
11
Pages
892-898
ISSN
  • 1475-3898 (ISSN-L)
  • 2044-5415
  • 2044-5423
DOI
10.1136/bmjqs-2016-006181
PMC
PMC5953211
OpenAlex
W2725461088
Cited by
23
References
50
Citations by year
2026: 2 · 2025: 5 · 2024: 1 · 2023: 2 · 2022: 2 · 2021: 2 · 2020: 6 · 2019: 3
FWCI
4.23
Type
journal article
Language
en
Open access
Locations
  • BMJ Quality & Safety (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • HighWire Press Open Archive (submittedVersion)
Funders
  • Memorial Sloan Kettering Cancer Center, Survivorship, Outcomes, and Risk Interdisciplinary Population Research Science Award
  • National Cancer Institute
Topics
  • Health Sciences › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
  • Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
  • Social Sciences › Business, Management and Accounting › Organizational Behavior and Human Resource Management › Healthcare Systems and Technology
Keywords
primary care physicians, oncologists, feedback culture, communication barriers, organizational learning, physician perceptions, safety culture, academic medical centers
MeSH terms
Academic Medical Centers, Oncologists, Attitude of Health Personnel, Communication, Female, Humans, Interprofessional Relations, Male, Focus Groups, Delayed Diagnosis, Physicians, Primary Care

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