Zeitschrift für ärztliche Fortbildung und Qualitätssicherung
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Z Arztl Fortbild Qualitatssich · Aug 2004
Practice Guideline Guideline[The German Guideline Clearinghouse on Breast Cancer: the need for frequent updating of breast cancer guidelines requires effective guideline updating procedures].
In order to promote the quality of health care and guidelines in Germany the German Guideline Clearinghouse (Sponsors: German Medical Association, National Association of the Statutory Health Insurance Physicians, German Hospital Federation, Associations of the Sickness Funds and the Statutory Pension Insurance) was established at the Agency for Quality in Medicine (AQuMed) in 1999. The results of the 10th Guideline Clearing Project, the Guideline Clearing Report "Breast Cancer", were published in December 2003. In a systematic search using English/German language guideline databases and literature databases (Medline, Healthstar, Embase), 16 national guidelines were identified which were in accordance to the inclusion criteria (breast cancer treatment; German or English language; published after 1992; new guideline or genuine update (no adaptation); recommended for country-wide implementation). ⋯ From the beginning, patients should be involved in the development process within a multidisciplinary team. Due to the rapid emergence of new evidence, oncology guidelines need an effective procedure for updating in order to ensure that they are able to promote health care quality by giving current recommendations based on best available evidence. International networks such as the Guidelines International Network (G-I-N) will be helpful to collect and appraise the evidence for the national guideline development groups in an effective way.
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Z Arztl Fortbild Qualitatssich · Jun 2004
[Teaching courses on aspects of medical history taking and communication skills in Germany: a survey among students of 12 medical faculties].
Good communication between patients and doctors has positive effects on health and the patients' quality of life. Communication skills can be trained. In many countries communication skills training is an important part of medical education and continuing medical education. In this study German medical students were questioned about current communication training. ⋯ Although these results are not representative, they give a general idea of communication skills teaching in Germany. During their clinical education students should be especially trained for difficult situations in the patient-doctor encounter. The international experience of other Medical Schools should be taken into account when implementing communication skills training as part of medical education.
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Z Arztl Fortbild Qualitatssich · May 2004
[Fragmentation of the doctor-patient relationship as a result of standardisation and economisation].
Standards, guidelines and evidence-based medicine are suitable means to strengthen the doctor-patient relationship, but will have the opposite effect if they are unrelated to the subject and fail to address the patient's needs. This may be the case with collective agreements in terms of socialised medicine which serve to restrict the patient's individuality in favour of rigid austerity measures and rationing. For this reason, rationing can only be a political instrument; it should never be applied to the doctor-patient relationship. ⋯ Currently, the introduction of all these programmes means adding to the immense burden on medical doctors, which in turn will produce negative effects on time and personnel. If the application of the working time legislation is to be observed, then the hospital doctor is threatened with becoming either a temporary agency worker or a professional holiday-maker. If the doctor-patient relationship is to be strengthened then this can only be achieved through the quality of the medical services provided and humane patient care.
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Z Arztl Fortbild Qualitatssich · May 2004
[The influence of medical standards, medical guidelines and economic restrictions on the standard of legal liability].
First we will have to identify the components determining the standard for medical liability in civil law cases. The civil courts have so far uniformly regarded the medical standard defined by physicians themselves as the standard of legal liability. Medical standards are based on scientific knowledge, practical experience and professional acceptance. ⋯ With reference to the civil law, though, others demand that the medical standard must be given top priority. In accordance with the latter opinion rationing is only permitted in cases of a natural shortage of resources. Shortage of economic resources must not influence the standard of legal liability.
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Z Arztl Fortbild Qualitatssich · Mar 2004
[The process of shared decision making in chronic pain patients. Evaluation and modification of treatment decisions].
Conditions affecting the musculoskeletal system are the cause of approximately 25% of absenteeism from work. Fibromyalgia syndrome is an exemplary condition of chronic widespread pain which most physicians consider difficult to manage. The physician-patient relationship is burdened with resignation and frustration on both sides. ⋯ In 87.2% of the consultations the therapy decisions were modified within three months after the first encounter. Patients considered to be "difficult" were less likely to modify their decisions. The shared decision making process usually takes more than one consultation.