TY - JOUR T1 - Preventing gatekeeping delays in the diagnosis of rare diseases JF - British Journal of General Practice JO - Br J Gen Pract SP - 145 LP - 146 DO - 10.3399/bjgp18X695225 VL - 68 IS - 668 AU - Esther de Vries AU - Lisa Fransen AU - Marlon van den Aker AU - Bert R Meijboom Y1 - 2018/03/01 UR - http://bjgp.org/content/68/668/145.abstract N2 - GPs acting as gatekeepers render a healthcare system easily accessible as well as affordable. However, gatekeeping can have an important drawback: it may hamper timely diagnosis and treatment of patients suffering from a rare disease (incidence <1:2000),1 especially if patients present with common symptoms. This delays referral, possibly resulting in permanent organ damage, reduction in quality of life, and increased healthcare costs. In this article we reflect on both organisational and GP factors that contribute to the problem, and offer suggestions on organisational and educational approaches to tackling it.Timely recognition is not only a problem for GPs: patients also travel between different healthcare professionals throughout the healthcare system. Ideally, these patient ‘journeys’ are organised as ‘care chains’ with the GP guiding and supporting the patient, but, in practice, this is often not the case. This causes problems that are also organisational in nature. Two related business disciplines that are rather unconventional in the (bio)medical field, operations management (OM), and supply chain management (SCM), could be used to reflect on the problem.2,3 OM concentrates on the operational activities necessary for the creation of a single company’s output (goods and/or services). SCM aims to improve the delivery of orders to customers that require the collaboration of different organisations. For patients travelling through various dissimilar parts of the healthcare system, the SCM approach can support our analyses.4 An SCM approach would particularly focus on interorganisational requirements needed for a smooth patient journey through the system.The many patient handovers during troubled patient journeys increase the possibility of errors because information is lost.5 … ER -