[Extrajudicial expert assessment--what is the basis for complaints against internists?]

In 1981, the Swiss Medical Association (FMH) set up an expert medical evidence office, from which patients or their dependents could request an extra-judicial expert report in cases of suspected error in diagnosis or treatment. Up to the year 1995, this office issued a total of 1675 expert reports, of which 109 were for the specialty of Internal Medicine. Since the office was founded, the number of expert witnesses called upon has continued to increase. The most common accusation was "failure to investigate or delay in investigation" (41 times, 48.2%) followed by the accusation of a "diagnostic error" (35 times, 41.2%). In 13 cases (20%) the expert report confirmed there had been a medical error, 46 (70.8%) negated such a finding, and no firm conclusion was reached in 6 expert reports (9.2%). Expert reports are very often requested by patients with malignant neoplasms, particularly if the disease is first diagnosed at an advanced stage, and these are associated with the most frequent accusation of delayed investigation. Communication problems between doctor and patient are a recurrent theme throughout the expert reports and this shows the importance of taking the patient's concerns seriously, of a well-founded explanation, and of being ready to discuss matters.