Who is to blame for delays in diagnosis?

From Dr. Pauline Chen's column in the New York Times:

...diagnostic failures are often due to missed steps, so-called “process of care lapses,” that stem from both doctors and patients.

In the June issue of The Journal of General Internal Medicine, for example, investigators from Harvard Medical School studied the records of over 100 women with breast cancer diagnosed late or at advanced stages and found that roughly a quarter of patients had experienced process of care lapses. Examples of such lapses included inadequate physical exams, delayed physician involvement and incomplete diagnostic and laboratory tests. But while the investigators discovered that nearly 20 percent of the women were missing as many as two or more steps in their care, they also found that doctors and patients contributed equally to the resulting diagnostic failures.

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