In this BJGP qualitative study, researchers interviewed 35 GPs, three other clinicians and three practice administrators from 31 practices in southern England about 'interim' diagnoses — the non-cancer label given first to a patient later found to have cancer.
Participants described interim diagnoses arising mostly when non-specific symptoms were attributed to a common differential diagnosis. Remote consultations were felt to make this more likely by limiting examination and information gathering. Not every delay was avoidable. Clinicians described safety-netting to prompt reattendance, an informal 'three strikes and you're in' rule for repeated presentations, a colleague's fresh look, and team discussion of uncertainty.
This is a description of clinician experience, not a measure of how often interim diagnoses delay cancer. But the strategies are cheap, and most family physicians in short consultations will recognise the problem.
- Label a working diagnosis as provisional in the notes when symptoms are non-specific.
- Reconsider the diagnosis when a patient returns a third time with the same complaint.
- Ask a colleague to review cases that are not following the expected course.
- Be cautious about closing a diagnosis after a remote consultation alone.
Why it matters
The commonest explanation is usually right, which is exactly why the uncommon one is missed.
Don't overread it
Qualitative interviews describe clinicians' views; they do not show how much delay interim diagnoses cause.
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