Scully C, Malamos D, Levers B G, Porter S R, Prime S S
Br Med J (Clin Res Ed). 1986 Sep 6;293(6547):599-601. doi: 10.1136/bmj.293.6547.599.
Referrals of patients with oral squamous cell carcinomas to an oral medicine clinic were assessed with regard to the sources, delays, and pattern of referrals from general medical practitioners and general dental practitioners. Slightly more patients were referred by dental practitioners than by medical practitioners, but general medical practitioners were far more likely to see advanced tumours and to request an urgent second opinion or suggest a diagnosis of malignant disease. The greatest delay overall was caused by the patients in seeking advice from their practitioner, particularly those who attended a general medical practitioner. Both groups of practitioners requested a hospital opinion within roughly a month--a reasonable interval. Subsequent delays were minimal. Delays occur mainly because the patients are slow in seeking professional advice and, in general, do not appear to have been reduced over the decade since a previous British study on referral patterns was carried out. This study emphasises the importance of educating patients about oral cancer since it is they who appear to be mainly responsible for the delays in diagnosis. The results also help to dispel the myth that general medical practitioners might be less competent at diagnosis and referral of patients with oral cancer than are dental practitioners, though we are aware of misdiagnoses from both groups.
对口腔鳞状细胞癌患者转诊至口腔内科诊所的情况，从全科医生和普通牙医的转诊来源、延迟情况及转诊模式等方面进行了评估。由牙医转诊的患者略多于医生转诊的患者，但全科医生更有可能见到晚期肿瘤患者，并要求紧急二次诊断意见或建议诊断为恶性疾病。总体而言，最大的延迟是患者向其医生寻求建议时造成的，尤其是那些去看全科医生的患者。两组医生都在大约一个月内请求了医院的意见——这是一个合理的间隔。随后的延迟极少。延迟主要是因为患者寻求专业建议的速度较慢，而且总体而言，自英国此前一项关于转诊模式的研究开展以来的十年间，延迟情况似乎并未减少。这项研究强调了对患者进行口腔癌教育的重要性，因为似乎主要是患者导致了诊断延迟。研究结果还有助于消除这样一种误解，即认为全科医生在诊断和转诊口腔癌患者方面可能不如牙医称职，尽管我们知道两组医生都存在误诊情况。
