[The physician as expert evaluator. Aspects of an ambivalent role exemplified by the evaluation of claims in legal health insurance].

This article provides a broad survey of the difficulties confronting the physician in his role as a specialist in the Health Insurance Medical Service assessing claims relating to the state medical insurance system. These problems can be divided into the three following categories. Firstly, problems on a personal level relating to the interaction of the different people involved, albeit within the given institutional framework. Secondly, problems involving matters of principle in reconciling diagnosis, the patient's subjective assessment of his condition and legal criteria. Thirdly, problems arising from the pressure created by socio-cultural developments which influence both the patient and the specialist physician in his assessment.