Biomedical subjects
Publications and source records attributed to G Carstensen.
Over a period of 20 years, the Mediation Committee Nordrhein settled more than 10,000 cases of supposed maltreatment. Only 4.2% of the cases concerned assumed faulty medication. In less than one third of them, maltreatment was recognized. Exact medical documentation is necessary for a fair and impartial settlement of the case.
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The demands on a medical witness are discussed. Physicians have to learn to deal with the legal conditions of their profession but lawyers have to be ready to understand the circumstances of the medical activity. Since 1975, independent medical bodies in the form of arbitration committees and expert boards have been founded in the Federal Republic of Germany. This extended the field of action for medical experts. However, a definition of the term "expert" is missing. There are rules for the continuing medical training by the German societies of physicians which should guide the courts.
Medicine has more severely changed during the last three decades than in the whole time before. The development may be summarized in one sentence: With it's new techniques in diagnostic and treatment, medicine has become more successful and at the same time more complex and more dangerous. To protect the reputation of this profession and to ease the relationship between physicians and patients regarding malpractice, independent medical bodies of experts in the form of arbitration or expert committees were introduced in Germany in 1975.
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Enough attention is still not being given to deep venous thrombosis in the leg--at least on an outpatient basis--and it is also underestimated. Immobilizing bandages are associated with the most danger. Medical prophylaxis of thrombosis is indicated in order to protect patients from injury and to accommodate forensic requirements. The number of malpractice suits is considerable and it is still going on. The advantages and disadvantages of immobilization bandages must be explained to the patients. If deep venous thrombosis is recognized and treated too late, the consequences are irreversible.
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For the relaxation of the physician-patient relationship from 1975 on Settlement Institutions and Expert Commissions were established at all General Medical Councils of the Federal Republic of Germany. The first Settlement Institution was founded on April 24th, 1975 in Bavaria, the first Expert Commission on December 12th, 1975 in North-Rhine. These institutions without example met all requirements and have stand the test. Quality standards are ensured by cooperation of lawyers. The 7288 reproaches of malpractice during the 12,5 years at the Expert Commission North Rhine are analyzed. Out of these 7288 reproaches 1126 cases of malpractice were assessed.
In two randomized prospective trials grafts impregnated with gelatine were compared to those not impregnated. In the first trial a double-velours graft (n = 50) was compared with a graft without velours trimming (n = 50) implanted in the aorto-iliac bifurcation. One half of the grafts in both groups were gelatine-impregnated. In the second trial 24 grafts without velours trimming (Cooley II, Meadox), 24 grafts manufactured by a new warp-knitting procedure without velours trimming (Protegraft 2000, B. Braun AG) and 24 identical grafts of B. Braun AG but with gelatine impregnation were evaluated. Gelatine-impregnated or not the grafts without velours showed no satisfying results. An elevated intraoperative bleeding incidence and a low two-years-patency rate of 64% were noted. On the other hand all double-velours grafts, gelatine-impregnated or not, showed a 100% patency rate two years after implantation. In the second trial a slight reduction in intraoperative blood loss was noted when using the gelatine-impregnated grafts.
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More differentiation than in the past is necessary for the indication of surgery in asymptomatic carotid stenosis. Surgery is indicated in the case of high-degree stenosis (above 80%) before major surgery, rapidly increasing stenosis--especially filiform stenosis--and if non-characteristic complaints are associated with cerebrovascular insufficiency or suspicious CT. Symptomatic carotid stenosis, however, requires surgical treatment. Unilateral asymptomatic stenosis below 70% requires careful observation and no surgery, particularly if the patient is older than 70 years. Surgical experience as well as collaboration with other disciplines are basic requirements.
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