Table 2

Open-ended responses to improve diagnosis (total responses=384)

CategoryExamplesN (%)
Address workload issues (including panel size, non-clinical tasks, time constraints)
  • Primary doctors need help. Many ‘burned out’. Physicians overworked because we have too many responsibilities other than caring for patients. Too many phone messages, clerical work and too many patients per physician.

  • Greater than half my time is spent on clerical matters or matters that a reliable intelligent teenager could perform.

  • More time per encounter would allow a more thoughtful and deliberate assessment and plan.

81 (21)
Reduce wait times for diagnostic tests and results
  • Make tests available in a timely manner.

48 (13)
Improve access to specialist and procedures
  • Increase access to specialists. Increase number of specialists in order to increase access.

  • Patients must be seen within 2 weeks of any referral submitted, not longer.

40 (10)
Ensure results are received and followed-up
  • More fail-safe systems to track what happened with abnormal results: did they get addressed? EHR will hopefully help with both.

  • Should set up a system where abnormal test result/studies flagged + make sure there is follow-up.

37 (10)
Address communication/collaboration between providers
  • Better communication when scheduling with our own providers when seeing each other's patients.

  • Improved communication between out pt MD and ER MD, so that report given by out pt MD actually gets to ER MD caring for the patient—perhaps on line or via fax—when I give report to triage nurse to give to ER MD, it often doesn't get relayed correctly.

  • Consultants need to respond to e-referrals via e-referrals or emails so PCP can communicate and follow-up with patients; which happens only 5% of the time now.

27 (7)
Address staffing issues
  • Reduce wait times. Hire more physicians and give them more time.

  • More support staff, RNs, MAs, LPNs, can help with work flow to give me more time to concentrate on my patients and diagnosis.

25 (7)
Address information maintenance/accuracy/access (including chart access and resources)
  • Would certainly stress the need for faster transcription turnaround time for ER notes and discharge summaries. It is frustrating, time consuming and poor medicine to see a patient for follow-up.

  • Hospitalisation and have no idea what happened.

20 (5)
Address responsibility issues related to tracking and follow-up
  • If a patient is seen by a consultant and that consultant feels that additional input is warranted from a 3 s consultant, then that 1st consultant should make a referral as opposed to sending patient back to PMD which may delay diagnosis 1–3 months.

  • Avoid the policy of ‘PCP default’ regarding abnormal test Flu.

19 (5)
Time to review results
  • Allow primary care provider's paid time to review growing amounts of data pertaining to patient care, labs/x-ray/test outside records.

17 (4)
Training opportunities (education including better history taking and diagnostic decision making and policy/procedures)
  • Education that is case-based. Take examples and educate MDs, build diagnostic skills and thinking.

  • Having protocols for most common missed or delayed diagnoses problems, that is, breast cancer/mast protocol in place now due to case here 5 years ago.

12 (3)
Improve computer system (design and configuration)
  • In changing to EMR, has been more difficult to follow lab results. Configuration of reports is harder to read.

  • Hard to get full picture of patient with having to look up each visit on the computer separately. Time consuming us flipping through chart. Tests, labs, radiology notes all in separate areas of computer!!

11 (3)
Address patient factors (education, communication, outreach)
  • Encourage patient for better follow-up.

  • By far biggest cause of delay in diagnosis is patients' reluctance to come in, usually out of denial and fear. We need to encourage patients not to delay, especially regarding skin and breast lesions.

11 (3)
Minimise denial/refusal/cancellation of consults
  • Specialty consultations should accommodate appoints especially if cancer is being considered without having to resort to admitting the patient in the hospital.

  • It is unbelievable that the specialists ‘close’ a referral when a patient hasn't called within a few weeks rather than phoning that patient by the department. Also, when a patient does call a day after ‘closed’ referral, they are denied an appointment.

  • Specialty referrals should not be denied.

9 (2)
Curbside consults
  • Encourage collaboration between primary care and specialists. On call Specialist carries a cell phone for ‘curbside’ consults.

  • All specialties need to have an on call phone/pager to easily access a quick consult: some of the specialties are good, some are terrible and essentially unavailable.

8 (2)
Address cross-coverage policy and procedures
  • When a provider is gone, often the labs and test results are not given to the relieving doctor. They just wait for the provider to get back.

  • Covering physicians should be just as responsible as physician responsible for test.

5 (1)
Miscellaneous comments (unable to classify)
  • Good to do periodic surveys like this. If implementable changes.

  • Reward the MDs for accomplishing high quality care and service per unit.

14 (4)
  • MA, medical assistant; EHR, electronic health record; EMR, electronic medical record; ER, emergency room; LPN, licensed practical nurse; MD, medical doctor; PCP, primary care physician PMD, primary medical doctor; RN, registered nurse.