Dr. Sabine Ziegler is a general practitioner with an interest in palliative care, practising in Ettlingen, Germany
For readers from Canada, a "mother land" of physician health, my reflections on physician health in Germany may surprise; the structures in Germany are not nearly as well developed as in the USA, Canada or Great Britain.
Doctors in Germany can prescribe and self medicate without any consultation or assessment by a colleague- which means drug misuse, including benzodiazepines, is possible. Long working hours, high professional responsibility and little recreational time lead to a large percentage of doctors feeling physically and psychologically affected. On top of that is the constant confrontation with suffering, fear and death. Doctors also often crumple under the high demands they create for themselves. It doesn't fit with a doctor’s self-perception to seek help for their own problems. Yet when a sick healer tries to cure himself most of the time it doesn't work. Every year around 150 German physicians end their lives.
There is no networked help system for sick doctors. The long existing online platform from the Institute For Physician Health goes more or less unnoticed. This German institute founded and led by Dr Bernd Mäulen is a centre dedicated to distributing all kinds of information about physician health (research, networking, prevention).
Guidelines for better treatment of physicians exist, but are seldom followed. Medical associations demand, time and time again, greater research efforts, practical aids, and programmes to improve the health of doctors, but they are never implemented.
There may be no structural change but I believe that something has changed: The current generation of 25 to 30 year old job entrants don't share the beliefs of their parents that: "a doctor is always healthy, efficient and able to work under endless pressure". Just as this generation doesn't accept a 10-12 hours working day with endless duties, there is growing acknowledgement of the importance of a good work-life balance. Changing attitudes required structural changes to the working lives of doctors and may encourage further development of structures to support physicians’ health. It is a revolution from below, rather than a planned and well-organised initiative from doctors’ associations. In the meantime, my impression is that younger colleagues don't accept the increasingly higher performance demand and often emigrate to neighboring countries.
As so often in Germany, organisation of programmes for physicians’ health might only work with a clear set of rules: I could imagine a routine obligatory medical check-up for every permanently employed doctor. As a contracted partner of health insurance companies, a doctor could be required to attend a specially organised occupational health service for doctors for routine health issues and undergo routine vaccinations and preventive medical examinations. This is accepted for pilots and firemen, who are also people who are trusted with other people’s lives. My friends in doctors’ groups (45-50 years old) have divided opinions: Especially the men who were afraid of routine check-ups…"if word gets out that I'm ill, nobody will come to my practice"…"I don't have the time to go to the doctors myself" "I can take care of myself"…..Only 6 out of 15 colleagues had a general practitioner. All the others managed their health by themselves. There is still much to be done…..