Riemann R, Demirbas O, Milewski C, Brehmer D
Städtische Kliniken Frankfurt a. M. - Höchst, Hals-Nasen-Ohren-Heilkunde, Kopf-Hals-Chirurgie, Frankfurt, Germany.
Laryngorhinootologie. 2010 Mar;89(3):151-6. doi: 10.1055/s-0029-1242752. Epub 2009 Dec 3.
More than one third of all lawsuits against surgeons include statements of insufficient or lacking preoperative informed consent which is mandatory in the german jurisprudence. Almost nothing is known about the postoperative patient's memory of risk factors which were explained prior to typical surgical procedures in ENT.
The objectives of this prospective study in 201 patients were to elucidate the actual clinical routine of obtaining informed consent for tympanoplasty (n=105) and FESS procedures (n=89), collect information on active and passive recall 6 weeks, 6 months and 1 year post-operatively, and to investigate whether patient age, sex, education, the time from obtaining consent to interview, recurrent vs. non-recurrent procedures, would influence the patient's recall capabilities.
In clinical routine, obtaining informed consent included 5 main items for tympanoplasty and 5 for FESS procedures made by the physician. Of the patients, 18.9% recalled actively and 65.3% passively. They named 1.5 items on average, with "deafness" as the leading complication in tympanoplasty and "amaurosis" in FESS procedures. Patient's memory was depending on the time from obtaining consent to interview and education exclusively.
In conclusion, the quantity of patient/physician interaction does not guarantee an increased effect on patient's recall. Improving patient interaction may reduce the probability of imminent accusations.
针对外科医生的所有诉讼中，超过三分之一包含术前知情同意不足或缺失的声明，而这在德国法律中是强制性的。对于耳鼻喉科典型手术前向患者解释的风险因素，术后患者的记忆情况几乎无人知晓。
这项针对201例患者的前瞻性研究的目的是，阐明鼓室成形术（n = 105）和功能性鼻内镜鼻窦手术（n = 89）获取知情同意的实际临床常规操作，收集术后6周、6个月和1年时主动和被动回忆的信息，并调查患者的年龄、性别、教育程度、从获取同意到访谈的时间、复发性手术与非复发性手术是否会影响患者的回忆能力。
在临床常规操作中，获取知情同意包括医生针对鼓室成形术列出的5项主要内容和针对功能性鼻内镜鼻窦手术列出的5项主要内容。患者中，18.9%能主动回忆，65.3%能被动回忆。他们平均说出1.5项内容，鼓室成形术中“耳聋”是主要并发症，功能性鼻内镜鼻窦手术中“黑矇”是主要并发症。患者的记忆仅取决于从获取同意到访谈的时间和教育程度。
总之，医患互动的数量并不能保证对患者回忆产生更大影响。改善医患互动可能会降低即将面临指控的可能性。
