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Letters Systems approach for early diagnosis of cancer

Systems approach applies to diagnosis of other conditions

BMJ 2023; 380 doi: (Published 29 March 2023) Cite this as: BMJ 2023;380:p704
  1. Sharon Dixon, general practitioner and NIHR doctoral research fellow1,
  2. Abi McNiven, senior qualitative researcher1,
  3. Danielle Perro, postdoctoral researcher2,
  4. Katy Vincent, associate professor, senior fellow in pain in women, and honorary consultant gynaecologist2,
  5. Magda Marečková, DPhil student2
  1. 1Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Oxford OX2 6GG, UK
  2. 2Nuffield Department of Women’s and Reproductive Health, University of Oxford, John Radcliffe Hospital, Oxford, UK
  1. sharon.dixon{at}

Black and colleagues recognise the complexity of journeys to diagnosis (or timely diagnosis).1 Their pragmatic, considered analysis resonates with our experience of clinical care, highlighting opportunities for improvement of a complex problem without simplifying or diminishing the challenges. These include considering potential diagnoses when the positive predictive value for symptoms in isolation might be low or uncertain or when symptoms occur variably, non-specifically, and across different body systems. …

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