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You are here: MEDICA Portal. Magazine & More. MEDICA Magazine. Topic of the Month. Volume archives. Our Topics in 2010. July 2010: Quality Management. Communication.

Listening to the Patient

Listening to the Patient

Photo: Human Ear

“I started studying medicine, because I wanted to deal with people. When I was all done with my studies, I had to deal more with quality assurance paperwork than people. That’s when I told myself: “I might as well go into politics yourself and abolish such nonsensical laws.“

You might be surprised about who made this statement regarding the subject of quality management. It was stated by Philipp Rösler, the German Federal Minister for Health. Rösler continues: “If there is great mutual trust between physician and patient, and if physicians and attendants receive the time for their professional ethos, you don’t need any quality assurance paperwork. “(1)

Fact is, the current political efforts aim exactly in the opposite direction. Starting this year, independent panel physicians are now also obligated to practice systematic quality management (QM). This means, they must have a QM-system implemented in their practice and meet requirements of a specification catalog, which was stipulated in the directive of the Federal Joint Committee (G-BA). Thus it’s not downsizing, but rather an expansion of the very bureaucracy, Rösler criticized.

The framework is not right

It will be interesting to watch whether Rösler’s cited position will be found again in future developments in health-care politics. To put it plainly: Will eventually a framework for medical science be created, where communication between physician and patient will have adequate significance? Communication as a trust-building, perhaps even healing promoting basic measure, and also communication as a valuable tool for purposeful quality management that’s geared toward patient’s needs.

Even though the German health care system does not look all that bad in an international comparison when it comes to the quality of medical care, German patients are dissatisfied. According to a report of the IQWiG (Institute for Quality and Efficiency in Health Care), in Germany waiting times for example are the shortest and Germany offers the most choices of medical practitioners and most reliable laboratory findings. Even so, Germans rate their health care system significantly inferior compared to how US-Americans or the British rate their system for example. (2)

What exactly do patients expect from a good physician, and what are they currently missing from their medical care? Looking into these questions might be a great guidepost for planning quality assurance measures.


Photo: Doctor and patient talking

Patients want one thing more than anything: more communication

In this connection, the result of a representative survey of 1500 men and women between the ages of 18 and 79 about their experiences and wishes concerning quality medical care, is very revealing. (3) Regardless of what the aspect and central theme of the question were, one conclusion was a similar thread within all of the answers: Patients would like more communication and see more social skills.

The negative experience ranked at number 1 is the enormous time pressure under which physicians need to medicate. Almost 100 percent of all surveyed persons insist that “a physician’s training should not just include medical knowledge, but also empathy and communication skills.“ The pay system should be aligned in a way, where an extensive conversation with the patient is financially profitable for the physician. This point was also one that almost all respondents approve of.

Often it is very simple things that go wrong

Good communication between physician and patient is perhaps the most effective measure for quality assurance. Often it is the very simple things, which can noticeably impair the quality of medical care of patients. A long waiting time for instance, the prime example for poor organization, can be significantly shortened mostly through simple measures. Whether it’s interpersonal, organizational or medical- no matter where the grain of salt is, it’s always the patients who are affected and who therefore can best reflect on the problem.

Communication by no means has to always be time-consuming. And by no means is lacking time always the reason why there is not enough communication between physician and patient in Germany. Slip boxes, like the ones that are now displayed in many doctor’s offices in accordance to the QM guideline, are certainly not a bad way to find out about a patient’s opinion. But something entirely different is much more important: openness for a conversation.


1. Federal Ministry for Health, Interview with Philipp Rösler by the German newspaper Bild-Zeitung on 11-1-2009

2. Sawicki, Peter : The quality of medical care in Germany – A randomized simultaneous comparison of six federal states from a patient’s viewpoint, Medizinische Klinik 2005;100:755-68

3. Marstedt, Gerd, Landmann, Juliane: Quality assurance in the care system – patients demand large scale changes, Gesundheitsmonitor 4/2009

Ulrike Viegener

(Translated by Elena O'Meara)


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