Posner K L, Caplan R A, Cheney F W
Department of Anesthesiology, University of Washington School of Medicine, Seattle 98195-6540, USA.
Anesthesiology. 1996 Nov;85(5):1049-54. doi: 10.1097/00000542-199611000-00013.
Expert opinion in medical malpractice is a form of implicit assessment, based on unstated individual opinion. This contrasts with explicit assessment processes, which are characterized by criteria specified and stated before the assessment. Although sources of bias that might hinder the objectivity of expert witnesses have been identified, the effect of the implicit nature of expert review has not been firmly established.
Pairs of anesthesiologist-reviewers independently assessed the appropriateness of care in anesthesia malpractice claims. With potential sources of bias eliminated or held constant, the level of agreement was measured.
Thirty anesthesiologists reviewed 103 claims. Reviewers agreed on 62% of claims and disagreed on 38%. They agreed that care was appropriate in 27% and less than appropriate in 32%. Chance-corrected levels of agreement were in the poor-good range (kappa = 0.37; 95% CI = 0.23 to 0.51).
Divergent opinion stemming from the implicit nature of expert review may be common among objective medical experts reviewing malpractice claims.
医疗事故中的专家意见是一种基于未阐明的个人观点的隐性评估形式。这与明确的评估过程形成对比，明确评估过程的特点是在评估之前就规定并阐明标准。尽管已经确定了可能妨碍专家证人客观性的偏差来源，但专家审查的隐性性质的影响尚未得到确凿证实。
麻醉科审查人员对成对的医疗事故索赔中的麻醉护理适宜性进行独立评估。消除或控制潜在的偏差来源后，测量一致程度。
30名麻醉科医生审查了103项索赔。审查人员对62%的索赔达成一致，对38%的索赔存在分歧。他们一致认为护理适宜的占27%，认为护理不太适宜的占32%。经机遇校正的一致程度处于差到好的范围（kappa = 0.37；95%CI = 0.23至0.51）。
在审查医疗事故索赔的客观医学专家中，因专家审查的隐性性质而产生的不同意见可能很常见。
