How often do doctors make mistakes

Quality assurance: Doctors make few mistakes

Every year the expert commissions and arbitration boards of the medical associations present the results of their examinations. In 2018, the number of applications fell further. Only a quarter of the suspected malpractice were actually confirmed as malpractice.

In three quarters of the procedures they examined, expert commissions and arbitration boards of the medical associations could not find any medical treatment errors in 2018. This emerges from the statistics of the organizations, which were presented in Berlin at the beginning of April.

Specifically, the expert commissions and arbitration boards brought 5,972 cases to a conclusion last year. No error was found in 69 percent of these cases. An error was found in six percent that was not causally related to the application. A medical malpractice was confirmed in 25 percent. That was 1,499 cases.

The chairman of the Standing Conference of the Expert Commissions and Arbitration Bodies, Prof. Dr. med. Andreas Crusius put these numbers in connection with the number of all treatment cases in Germany. "For the statistical year 2017, the Federal Statistical Office reported 19.5 million treatment cases in the hospitals," he said. "In addition, there are around a billion doctor contacts in the practices every year." Measured against this enormous total number of treatment cases, the number of errors found is again in the per mille range this year (see Figure 1).

If patients suspect a medical malpractice, they can turn to the expert commissions and arbitration boards, where doctors and lawyers check whether there has actually been a medical malpractice. The confirmed errors were divided into six degrees of severity in the statistics.

For 2018, in 16 of the 1,499 cases, minor damage was determined, in 618 cases a temporary light to moderate damage, in 188 cases a temporary severe damage, in 462 cases a light to moderate permanent damage, in 127 cases a severe permanent damage, and in 88 cases the patient died after the malpractice.

"Temporary medium damage is, for example, pain that occurs as a result of treatment," said the managing director of the arbitration board for medical liability issues of the North German Medical Association, Andreas Dohm. "Serious permanent damage is, for example, amputations or paralysis."

Trauma surgery is often affected

Dohm explained which specialties are most likely to seek medical malpractice investigations. In the private practice, trauma surgery and orthopedics were primarily involved (in 402 cases), followed by general practitioners (229 cases) and general surgeons (136 cases). When it comes to general practitioners, however, it should be noted that the total number of treatment cases is very high, explained Dohm. In the hospital, the specialist areas most frequently involved were trauma surgery and orthopedics (1,690 cases), general surgery (680 cases) and internal medicine (455 cases).

The Medical Chairman of the Arbitration Board for Medical Liability Issues of the North German Medical Association, Prof. Dr. med. Walter Schaffartzik, explained why so many procedures are opened in trauma surgery and the orthopedic surgeon: “Trauma surgery lives from the results of the imaging procedures. This is another reason why you can immediately see if there have been errors in this area. ”In cardiology, for example, an error is not always immediately apparent. Experience has shown that patients have particularly high expectations in orthopedics. That too could lead to an increased number of applications.

Dohm also named the diseases that most frequently led to an application: gonarthrosis (198 cases), coxarthrosis (185 cases) and femoral fracture (143 cases).

The most common types of errors in the private practice were the imaging procedures as part of the diagnosis (144 cases), the anamnesis as part of the diagnosis (64 cases) and the surgical treatment (63 cases). In the hospital, the most common types of errors were operations (416 cases), diagnostic imaging (323 cases) and indication (160 cases).

Number of applications is falling

Dohm said that 76 percent of the cases examined in 2018 were in the hospital and 24 percent in the outpatient setting, including medical care centers. He pointed out that not every application leads to arbitration. If the doctors involved did not agree to the opening of a procedure, for example for reasons of liability, no procedure could be carried out. In northern Germany, around 2,500 proceedings were opened for around 4,000 applications.

The number of requests for a possible malpractice investigation continued to decline slightly over the past year. It fell from 11 100 applications in 2017 to 10 839 in 2018 (see Figure 2). In 2012 there were 12 232 applications. Schaffartzik gave reasons for this decline. On the one hand, there was a climax in 2012 as a result of the Patient Rights Act. "The law has brought more public attention to medical errors," he said. On the other hand, the medical profession has done a lot in recent years to strengthen patient safety (see previous article).

Crusius emphasized that good communication counteracts malpractice. "Good communication between doctors and patients can prevent misdiagnosis, poor compliance and misunderstandings about the treatment goal," he said. “For example, before an operation, it should be clarified in detail what the patients expect and what is medically feasible. Because not everything the patient wishes for is actually feasible. ”This alone avoids later accusations of treatment errors due to exaggerated expectations of the success of the treatment.

Seek conversation with patients

Crusius also advised the doctors to talk to the patient after a medical malpractice: "When doctors talk to their patients about undesirable results, the patient often does not immediately complain." In addition, it is good to let the patients know about their existence to clarify the expert commissions and arbitration boards.

Crusius, on the other hand, criticized many political guidelines of the past. "The economic framework conditions created by politics over decades are not geared towards maximum patient safety, but towards maximum efficiency," he emphasized. “Treatment pressure can encourage treatment errors. In the rescue centers and on the wards, doctors sometimes have to decide in seconds about potentially life-saving measures - sometimes with patients who are completely unknown to them. “It is remarkable,” says Crusius, “how seldom they go wrong.” Falk Osterloh

Example: faulty interface management

A common reason for a suspected medical error is the faulty interface management between the inpatient and outpatient areas, explained the medical chairman of the arbitration board for medical liability issues of the North German Medical Association, Prof. med. Walter Schaffartzik. He gave an example from practice: The ureteral splint was removed from a 63-year-old patient in the hospital after an abdominal operation. The discharge letter to the urologist asked for the ureter to be removed. So the urologist tried to remove the splint endoscopically. When he couldn't find her, he had an X-ray taken. As a result, the patient complained of bleeding and severe pain. And X-ray diagnostics also represent bodily harm if it is carried out unjustifiably, explained Schaffartzik.

The verdict of the arbitration board of the North German Medical Association was as follows: There was a treatment error, since the incorrect information in the doctor's letter led unnecessarily and avoidably to an endoscopic attempt at removal and a radiological examination. The patient is entitled to compensation. "The damage is comparatively minor," said Schaffartzik. "It's not about the severity of the damage, but about the question of whether it can be traced back to a medical malpractice or not."