[Cardiovascular diseases and the subspecialties cardiology and angiology in "Schlichtungs"- Proceedings]

A: The Schlichtungsstelle (expert panel for alternative dispute resolution) of Northern Germany, in 2001, decided on 2620 malpractice claims; 233 of these were related to the treatment of cardiovascular disorders, coronary and venous diseases being the most common. The physicians involved in these disputes represented 18 (sub-)specialities. Complaints related to procedures were the ones most frequently submitted by the patients, followed by those concerning diagnostics. Negligence was found to be present in 37% of the cases, the highest proportion being due to mistakes of diagnosis, followed by organisational and system-related mistakes. Medical negligence as the cause of injury was assumed in 46/233 (20%) of the cases, the injuries being serious in 18 and fatal in 6 of the 46 patients. Negligent and non-negligent iatrogenic injuries combined, amounted to 132/233 (57%) of the "cardiovascular" panel cases. B: From 1992 to 2001, we collected 165 panel cases involving cardiologists and 3 involving angiologists. In most of these the underlying disease was coronary, but in 14 cases the underlying disorder was psychosomatic. 35% of the complaints submittted by the patients were about invasive procedures. 12% of the instances of negligence determined in the panel proceedings were due to procedural mistakes, whereas 47% were due to mistakes related to indication and to the monitoring of the patients after procedures. Negligent iatrogenic injury was assumed in 27%, non-negligent iatrogenic injury in another 53% of the cases, so that the total of iatrogenic injuries amounted to 80% of the "cardio-angiologists" panel cases. 19/168 (11%) patients died from iatrogenic injuries. Organization and coordination among medical persons and institutions treating patients need improvement. A considerable number of disputes and claims seems to be initiated and caused by deficits in doctor-patient-communication. Attempts at reducing negligence and adverse events should center around those professionals actually involved in patient care, where the decisions on diagnostics, indication and therapy are made. Processes promoting patient safety should be based and depend on the groups cooperating in their daily work (department, practice). External influences and directives tend to be less effective.