[Medical risk and iatrogenic injury--"accident reports" from the North German Schlichtungsstelle (expert panel for extrajudicial claims resolution)].

Schlichtungsstellen and Gutachterkommission--expert panels for extrajudicial malpractice claims resolution--are well positioned to provide data on iatrogenic injuries and negligence in medical care, based on the information collected from a great number of panel cases. Within the last 4 years, 2000 through 2003, the Norddeutsche Schlichtungsstelle concluded 10,513 Schlichtungsverfahren (panel proceedings), more than three quarters of them related to the surgical specialties; most of the claims addressed operations and postoperative therapy. In the nonsurgical specialities, the highest proportion of the proceedings had to do with procedures. These results are similar to those of population-based studies of adverse events by chart review. Decisions in favor of the patient were given in 25-30% of all the cases. But the proportion of all treatment-induced injuries determined in the proceedings of the Schlichtungsstelle amounted to 50-60% of all cases, and to more than 70% if operations or medical procedures were the medical problems in question. In cases where negligence was involved, most frequently diagnostics were at fault (the highest rate of errors was found in diagnostic radiology and imaging techniques), followed by injurious errors of operative technique and postoperative care. The risks of medical injury in older patients and of drug-induced adverse events are underrepresented in the cases of the Schlichtungsstelle. Deficient doctor-patient communication, claimed by about 25% of the patients in their initial correspondence to the panel, can only rarely be proved or disproved by documentation. Nevertheless, these deficits play an important role as risk factors for negligence and injury and even as causes of dispute and claims. In addition to communication with the patient, open and honest communication--and confidentiality--within the medical team are essential in managing the risks of error and injury in medical care.