A Chicago DPC Doctor Cites a 6.6-Year Endometriosis Delay. The Peer-Reviewed Review Says 6.8, and Never Addresses Visit Length.
The patient in Dr. Rajdeep Dhami’s October 13 Medscape commentary had symptoms that were each explained on their own. Bloating was worked up as irritable bowel syndrome. Pelvic pain was put down to anxiety. Iron deficiency was “treated and re-treated without anyone asking why.”
“The dots were already in her chart,” says Dhami, a board-certified family physician who founded AVAYA MED Direct Primary Care in Chicago. “What was missing was the time to connect them.”
The piece runs in Medscape’s 60-Second Consult series. Its argument is one many DPC physicians will recognize: uninterrupted time lets a clinician connect findings that were already on file. To size the problem, Dhami reaches for a number. “Average diagnostic delay in endometriosis runs about 6.6 years. A substantial portion of that delay accrues after she reaches primary care. That’s our share.”
The Research Desk traced that number. It holds up. What it can’t do is prove the fix the commentary proposes.
Where 6.6 years comes from
The figure matches a scoping review posted to medRxiv in January 2024. Its authors searched four databases through September 2023 and found 367 studies. Twenty-two met their criteria. Across those, the average time from first symptom to diagnosis was 6.6 years, with study averages running from 1.5 to 11.3 years.
That preprint has since been through peer review. The published version, in Health Care for Women International, reports 403 studies screened, 23 included and an average delay of 6.8 years, ranging from 1.5 to 11.4.
The commentary doesn’t cite a source, but its number matches the earlier draft of this research rather than the published one. Two-tenths of a year doesn’t change the point. Anyone quoting the figure now has a peer-reviewed number to use instead.
”That’s our share”
Dhami’s second claim is the sharper one: that a substantial part of the delay happens after the patient is already in front of a primary care clinician.
The preprint backs that. Among the studies that broke the delay into stages, symptom onset to a first primary care visit averaged 2.0 years. The next stage averaged 2.5 years. Gynecology referral to diagnosis averaged 2.8.
One caution on that middle number. The Results section describes it as the stretch from primary care to a gynecology referral. The Discussion section calls it “primary care presentation to diagnosis.” Read either way, the stage that begins in primary care averaged longer than the 2.0 years before patients first showed up.
The American picture is less tidy. The top of the preprint’s range, 11.3 years, came from a US study. A separate online survey of 638 US women, run in 2012 by researchers at AbbVie and published in 2017, found a mean of 4.4 years from symptoms to diagnosis. It also found that women diagnosed by an OB-GYN waited 21.5 months from first consultation, against 40.3 months for those diagnosed by other physicians. That’s the closest any of these sources comes to measuring what happens inside the primary care stretch.
What the review says it didn’t look at
The authors are direct about their limits. Every included study relied on patients recalling when their symptoms started. None used medical records to check those dates.
And on the question Dhami’s commentary turns on, the preprint is blunt: “none of the studies evaluated the number of consultations prior to referral.” The review never mentions visit length or time per visit.
The interventions it did find were different in kind. Two studies reported shorter times to diagnosis after clinical guidelines were introduced. One found specialist endometriosis centers cut the delay in the US, but not in the UK. A comparison of public and private care in one study found waits of 8.3 years against 5.5.
The open question
Dhami’s case is a single patient, offered as illustration, and the commentary doesn’t present it as anything more. Its closing line is careful too: “Whatever model you practice in, time is the resource worth protecting.”
The research supports half of that. Primary care holds a real share of a delay that averages close to seven years. Whether a 45-minute visit is what shrinks that share is something no study in this review measured. Clinical guidelines have two studies behind them. Visit length, for now, has cases like this one.
If you run a DPC practice and you see these patients, you might be sitting on the data that would answer it: how many visits before the cycle question got asked, and how long from there to a referral. Nobody in the review counted that.