[Results of 903 settlement proceedings in internal medicine]

Physicians - as others in their activities - err and may cause injuries to patients. The case material of Schlichtungsstellen and Gutachterkommissionen (expert panels for extrajudicial claims resolution) may provide suggestions as to the nature and gravity of negligent adverse events in medical care.

Cases are decided by members of the panel, one physician and one lawyer being responsible for each case. They assess, aided by external expert opinion, records for evidence of negligence and, in case of negligence, for a causal relation to injury. Given that relation, they recommend compensation in favor of the patient. Data on complaints, mistakes and injuries are filed.

We assumed negligence in 40 % of our 903 panel cases (most frequently due to mistakes in diagnosis, indication and monitoring after procedures), and negligent injury, resulting in recommendations for the patient in 26 %. In the 363 cases concerning invasive procedures (diagnostic, interventional, and injections) mistakes of indication outnumbered those in performing the procedure. Negligent injuries resulted in severe lesions or even permanent disability in 111 patients, in 30 patients in death. Even in the cases without evidence of negligence, many of the patients had suffered iatrogenic injuries.

Physicians must make decisions about complex problems, under very difficult circumstances (Eddy); diagnosis is mistaken frequently, and indication also. According to patients' complaints and to the relevant literature, communication is of crucial importance regarding the doctor-patient-relationship and the prevention of disputes. The number of treatment-caused lesions made visible by claims constitutes only a fraction of the total of iatrogenic injuries actually suffered by patients. The analysis of adverse events in medical care should include system-based sources of errors and untoward outcomes.