Factors associated with delay in the initiation of physicians' care among late adulthood persons.

Abstract

THE shift in the dominant pattern of Tillness from sudden-dramatic acute forms to gradual-insidious chronic forms has led to a modification of the concept of preventive medicine to include the early diagnosis and treatment of illness, as well as activities aimed at avoiding the onset of illness.' In its study of chronic illness in the United States, the Commission on Chronic Illness estimated that in nearly 40 per cent of all cases of chronic illness, unnecessary suffering and disability result because of avoidable delays in diagnosis and treatment.2 In the case of cancer of the breast alone, the American Cancer Society has stated that 82 per cent of all deaths could be prevented through early detection and treatment, in contrast to 37 per cent when treatment is delayed.3 Though there are exceptions, entrance into the health-care system is largely a matter of individual volition. The decision by the individual to initiate or refrain from initiating a physician's visit is an important element in the effective application of medical knowledge and technology.4 Generally speaking, the successful application of medical know-how calls for early diagnosis and treatment. Early diagnosis and treatment in turn requires the cooperation of the individual in the frequent and prompt initiation of health care. While there may be some question about the practicality of getting individuals to initiate care for illness in the preclinical stage (because of the difficulty of convincing individuals to see a physician when they are feeling well, problems associated with the accuracy and efficiency of mass screening and diagnostic technology, and resistance to change from traditions of private medical practice and the doctor-patient relationship), there appears to be little question among health professionals that