[Medicolegal aspects of tumor boards]. / Medizinrechtliche Aspekte von Tumorboards.

The presentation of tumor patients to tumor boards has widely developed into a medical standard. The necessary compliance to the medical standard can lead to obligatory presentation if the complexity of a case dictates that this cannot be comprehensively covered by a single treating physician. The organization of a tumor board must be so that the structure and specialist competence guarantees an adequate consultative function of the represented specialties. Tumor board members are not automatically promoted to become part of the treating team just by participation and therefore do not have a guarantor position but do have the obligation of care of a consulting physician. Tumor board decisions have a recommendation character, are not binding in the legal sense and do not relieve the treating physician from the obligation to critically scrutinize the recommendations before implementation. On the other hand the treating physician must be able to justify not following the recommendations on the basis of the medical obligation to care. The tumor board must fulfil the same requirements for documentation as any other consultative activity.

[Quality and management of preoperative patient information. Results of conventional and computer based documentation]. / Qualität und Management der Patientenaufklärung. Ergebnisse konventioneller und computergestützter Dokumentation.

INTRODUCTION: Analysis of the quality of different modes of preoperative information management on the example of primary total hip arthroplasty. Comparison between a since 10 years used, computer based system and a conventional procedure with additional hand-written notes. METHODS: Retrospective analysis of respectively 50 with conventional and computer based system written preoperative patient information. The completeness of the documentation is examined according to the demands of current judgement. RESULTS: The results confirm, independent from the level of education, a complete documentation of all risks by applying the computer based system, whereas the conventional method leads to considerable lacks of documentation. DISCUSSION: The computer based system guarantees a high quality of preoperative patient information which cannot be obtained by the conventional method and therefore offers a protection against unjustified claims of liability.

[Risk management as a means of quality assurance in the hospital]. / Risk-Management als Mittel der Qualitätssicherung im Krankenhaus.

Each modern organized hospital needs an effective risk-management. This does not only mean to avoid incidents to reduce insurance costs to a low level. Reduced on this aspect, the hospital management will not be able to reach a broad acceptance for the tasks of risk-management. Each physician naturally avoids incidents in daily hospital routine by following good medical practice in medical treatment. At the same time positive statistics will guide to an optimized high valued treatment quality. At first, critical situations have to be managed when they occur. A critical situation is very often forgotten after successful management and quality deficits stay as they are. Knowledge from the daily hospital routine are not used, procedures are not improved. There is no system of perpetous monitoring installed. Risk-management will guide to a process of continuous quality improvement in high risk departments, where processes and structures are not as good as they could be. In addition to measurements forseen by law, risk-management means constant evaluation of the quality of the own hospital treatment. Risk-management is not only extern quality assurance but also a intern program. It opens a wide field for self responsible measurements and own creativity in practical implementation.

[Treatment of pain and information of patient]. / Patientenaufklärung in der Schmerztherapie.

Treatment of pain is an medical operation that requires informed consent of the patient as justification. Invasive treatment of pain causes frequently civil and sometimes even criminal responsibility of the physician which can be reduced by detailed information about typical risks. Information about abuse, physical and psychological dependence and consequences on the ability to operate a vehicle must be a part of a medicinal treatment. In any treatment, the patient has a right to information about serious alternative methods. It is the responsibility of the physician to inform the patient in a personal dialogue. Information forms can support but not replace the dialogue. In case of minority of the patient or missing expression of will the physician has to inform the legal representative(s) or to search for the presumed will of the patient. The information about post operative treatment should take place before the operation to keep the patients consent free of influence of anesthesia or pain caused by the operation. Treatment of pain is often not vital and additional to treatment of the basic disease, so that the physician has to inform both about the treatment of pain and of basic disease. Even by final disease a renunciation of information is possible only under very restricted circumstances. Documentation has to be a part of any information to avoid lack of evidence in a trial.

[Modification of the prescribing practice of the physician by legislation with special reference to non-approved drugs]. / Beeinflussung der Verordnungsweise des Arztes durch die Rechtsprechung unter besonderer Berücksichtigung nicht zugelassener Arzneimittel.

Prerequisite for any prescription is the doctor's basic knowledge on the benefits and risks of the medicine. Under the obligation to exercise due care, the physician may even prescribe non-registered medicines if scientifically justified. Exceptionally, the use of a non-registered medicine is even imperative.