There are few things more depressing in the life of a busy medical or surgical consultant than the procession of patients who arrive at his door with hopelessly advanced cancer of the stomach. As he sees them, he must keep asking himself, "Why did they not come earlier?" and "What has kept them away?" He knows, of course, that one of the greatest difficulties is that so often the patient is slow to realize that he is seriously ill. Symptoms of indigestion, if present at all, are mild and not such as cause alarm. But the reading of a few records will show that even when the symptoms are ominous, many persons will evince no concern and will wait for months or years before they seek help and advice. Still more surprising is the fact that many patients who early consult one or more physicians are allowed to drift along
ALVAREZ WC. HOW EARLY DO PHYSICIANS DIAGNOSE CANCER OF THE STOMACH IN THEMSELVES? A STUDY OF THE HISTORIES OF FORTY-ONE CASES. JAMA. 1931;97(2):77–83. doi:10.1001/jama.1931.02730020005002
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