title: [Structure and limitations of past and future functions of hospitals in Germany from the physicians's point of view].
abstract: The present paper describes the emergence of hospitals from the xenodochia of the early Christian period up to the hospitals founded in the middle of the 19th century. Based on this tradition the development of German hospitals up to the present day has been influenced by the increase in scientific medical knowledge (anaesthesia, asepsis, antisepsis, roentgenology). Also, the differentiation of the traditional medical specialties into additional special fields and branches will be illustrated. Here, a special role may be attributed to both the laws and regulations releasing hospitals from the care for the invalid and elderly and a change in the prerequisites for hospital financing, which finally led to today's German hospitals being "acute care hospitals". Especially after World War II, the organisation and management structure of German hospitals were also affected by socio-political changes; it will be emphasised that the pyramidal structure (hierarchy) of quality, experience and competence is an indispensable requirement, which particularly applies to the structure of the medical staff. When a human being falls ill he does so as an entire psychophysical unit; the medical care for the diseased person must therefore not regard this unit that forms man as arbitrarily divided individual sections. The development of modern health technologies (such as--to mention just a few--dialysis, ultrasound, endoscopy, cardiac catheterisation, computed tomography, magnetic resonance imaging) should not lead to a complete autonomy of process engineers and thus to the splitting up of medicine into individual allotments because such an approach would be based on an utterly erroneous perception of man. In German hospitals, measures of internal quality assurance have been known for ages, long before politicians also discovered the necessity of so-called external quality assurance in medicine. Quality assurance has always been a matter-of-factness with hospitals. The presentation of the quality of hospital care to the outside world is a necessity. Scientifically founded clinical guidelines will be welcome in hospitals if they identify the necessary lower limit on medical practices by summarising the world-wide knowledge about diagnosis and treatment and if they are regularly checked and updated. But guidelines determining an upper limit on medical practices serve economical purposes only, fixing the manoeuvring space for practising the art of medicine to the disadvantage of the patients and transforming medicine from an attention-giving into an allocation-oriented profession. The future of German hospitals will only partially depend on the progress achieved in the medical sciences; to a greater extent it will be restricted by political decisions and general economic conditions.
authors.forename: Hermann
authors.initials: H
authors.lastname: Hoffmann
mesh_terms: D005858:Germany; D006761:Hospitals / Q000592:standards; D006801:Humans; D008505:Medical Staff, Hospital / Q000592:standards*; D010817:Physician-Patient Relations