Güven Asim, Kols Kerstin, Fischer Klaus, Schönberger Michael, Allert Sixtus
Sana Klinikum Hameln Pyrmont, Plastische und Ästhetische Chirurgie, Handchirurgie.
Schlichtungsstelle für Arzthaftpflichtfragen der norddeutschen Ärztekammern.
Handchir Mikrochir Plast Chir. 2017 Sep;49(4):251-256. doi: 10.1055/s-0043-118599. Epub 2017 Sep 28.
In Germany, Hand Surgery is an additional qualification that can only be obtained by a three-year training after a completed residency in General Surgery, Plastic Surgery or Trauma and Orthopaedic Surgery. Nevertheless, injuries and diseases of the hand are also treated by physicians without this particular qualification. It is questionable whether these treatments more often lead to medical malpractice. 376 charges of medical malpractice in surgical treatments of the hand and forearm that were closed in 2014 and 2015 were collected by the Arbitration Board for Medical Liability Issues of the Medical Association of North Germany.Cases with proven medical malpractice were classified by the qualification of the physician in charge and analysed. A statistical analysis was performed with the use of the program SPSS (IBM). Medical malpractice was proven in 42 of 113 cases with an attending physician who held the additional qualification for Hand Surgery (37.2 %). For physicians without this qualification, the figures were 79 out of 155 (51.0 %) in the group of trauma and orthopaedic surgeons and 54 out of 108 (50.0 %) in the group of general surgeons. The differences between the hand surgeons and the trauma and orthopaedic surgeons (p = 0.017) and between hand surgeons and general surgeons were significant (p = 0.037). It was shown that physicians with an additional qualification in hand surgery had signifcantly fewer proven medical malpratice cases than physicians without this qualification. The following trends were observed in the cases of the physicians without the additional qualification in hand surgery: underestimation of the severity of trauma to soft tissues and infections of the hand, errors in the surgical examination of the hand, including functional tests of tendons and nerves, as well as in diagnostic findings after X-ray studies of the hand.
在德国，手外科是一项额外资质，只有在完成普通外科、整形外科或创伤与矫形外科的住院医师培训后，再经过三年培训才能获得。然而，手部损伤和疾病也由没有这项特殊资质的医生治疗。这些治疗是否更常导致医疗事故尚存在疑问。德国北部医学协会医疗责任问题仲裁委员会收集了2014年和2015年结案的376起手部和前臂外科治疗医疗事故指控。对有医疗事故证据的病例，按主管医生的资质进行分类并分析。使用SPSS（IBM）程序进行统计分析。在113例由具备手外科额外资质的主治医师治疗的病例中，有42例被证明存在医疗事故（37.2%）。对于没有这项资质的医生，在创伤与矫形外科医生组中，155例中有79例（51.0%），在普通外科医生组中，108例中有54例（50.0%）。手外科医生与创伤与矫形外科医生之间（p = 0.017）以及手外科医生与普通外科医生之间的差异具有统计学意义（p = 0.037）。结果表明，具备手外科额外资质的医生被证明存在医疗事故的病例明显少于没有这项资质的医生。在没有手外科额外资质的医生的病例中观察到以下趋势：对手部软组织创伤严重程度和手部感染的低估、手部外科检查（包括肌腱和神经功能测试）以及手部X线检查后的诊断结果方面的错误。
