Delayed Diagnosis and Specialist Referral - A Persisting Dilemma in Medical Practice: A Case Report

Delay in diagnosis and most importantly delays in specialist referrals have been known for many years. Despite intense efforts by the fathers of medical ethics to reverse the trend, it is still lingering in present times. This is even more pronounced in the rural settings of the low economic countries. The contending variables may be primary care physicians based, patient based and health care system based. On the part of the primary care physicians, it calls for a review of the medical ethics, concerns for continuing medical education backed up by attitudinal change to give priority to patient outcome and then make moves to correct patient and health care system based variables. This will translate to our patients receiving the best and timely care with good outcome. We report a sixty-five year old retired civil servant who presented to our facility with a two year history of penile growth that was first noticed in the incompletely circumcised prepuce. This was excised in a peripheral hospital within a month of noticing the growth followed by daily wound dressing. No histological examination of the excised tissue was done. The lesion grew and invaded proximally to involve the proximal third of the phallus which prompted him to abandon the care and came to University of Uyo Teaching Hospital. He was seen and an incisional biopsy taken for histology which turned out to be well differentiated squamous cell carcinoma. He was offered a total penectomy and a perineal urethrostomy to which he consented in writing. This report seeks to highlight preventable morbidity in medical care, identify some key variables that may account for delays and to suggest subtle solutions for better treatment outcome for our patient