international consensus statement
international consensus statement
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DOI：
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发表时间：
2000
期刊：
影响因子：
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通讯作者：
R. Clements;A. Simanowitz
中科院分区：
文献类型：
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作者：
R. Clements;A. Simanowitz
当AVMA在1982年成立时，很少有脑瘫案件被提起诉讼；那些总是败诉的案件。造成这两种情况的原因是索赔律师缺乏技能。随着这些技能的发展，病例数量和成功率都有所增加。20世纪80年代末，索赔人取得了如此大的成功，以至于产科医生开始恐慌。很明显，他们或他们的法律顾问正在开发两种方法来对抗他们认为近乎流行的疾病和对该行业本身的威胁第一是防御性医学的概念；通知说，由于害怕诉讼，产科医生进行了不必要的剖腹产，损害了母亲和卫生服务。第二种方法是移动球门柱。在此之前，脑瘫诉讼的主要问题一直是疏忽。被告发现，索赔人律师的新技能加上专家证人的支持，这些专家证人经验丰富得多，并准备在他们的做法显然不可接受的情况下批评他们的同事，这意味着证明疏忽变得容易得多。因此，起因问题--显然是一个复杂得多的问题--开始被更频繁地提出。以至于近年来，大多数脑瘫的行为都是有争议的，并不总是因为疏忽，而往往仅仅是因为因果关系。大约在那个时候，一些学术科学文章开始出现在医学文献中，尤其是在美国，这表明了证明因果关系是多么困难。那些代表患者的人中更愤世嫉俗的人认为这是一个有趣的巧合。事实上，A VMA医学和法律杂志早期版的一篇社论
When AVMA was founded in 1982, few cases of cere bral palsy were litigated; those which were invariably lost. The reason for both was the lack ofskills on the part of claimant lawyers. As these skills developed, both the number of cases and the success rate increased. Towards the end of the 1980s, claimants were having so much success that the obstetricians began to panic. It became clear that they, or their legal advisors, were developing two methods of counteracting what they saw as a near epidemic and a threat to the profession itself The first was the concept ofdefensive medicine; notice was given that, because of the fear of litigation, obstetricians were carrying out unnecessary Caesarean sections, to the detriment ofmothers and to the health service. The second method was to move the goal posts. Until then, the main issue in the cerebral palsy litiga tion had been that ofnegligence. The defendants were finding that the new skills of the claimants' lawyers, together with the support ofexpert witnesses who had become far more experienced and were prepared to criticize their colleagues when their practice was clearly not acceptable, meant that negligence had become far easier to prove. As a result, the issue ofcau sation - clearly a far more complex one - began to be raised more frequently. So much so that in recent years, most cerebral palsy actions are disputed, not always on negligence, but often solely on causation. Around that time, a number of learned scientific articles began to appear in the medical literature, par ticularly in the United States, showing just how diffi cult it was to prove causation. The more cynical amongst those representing patients regarded this as an interesting coincidence. Indeed, an editorial in an early edition of the A VMA Medical and Legal Journal