German healthcare system: The victim role of general practitioners and specialists in Germany

What it’s all about

According to the public statements of professional organisations and interest groups, as well as self-portrayals in practice management comparisons, many German doctors see themselves as victims. This perception is characterised by various external and internal factors, which this article examines and shows the reasons behind this perception.

Business management methods as an expression of the pursuit of profit

In modern medicine, the use of business management methods is essential to ensure the efficiency, sustainability and quality of patient care in a practice. This fact is emphasised to doctors from many sides. However, for many doctors, this approach and the demand for more entrepreneurial thinking and action is at odds with their traditional self-image as altruistic healers. Historically, the medical profession has always been associated with a high degree of ethical and moral behaviour. The use of such methods and instruments is therefore often perceived as commercialisation and alienation from the original ideals of medicine.

This discrepancy leads to an identity crisis. Doctors have learnt in their training that the patient is at the centre and that economic considerations should only play a subordinate role. The pressure to act in a commercially efficient manner clashes with this self-image and creates the feeling of betraying one’s own values. This feeling of inner conflict is reinforced by social stereotypes about profit-oriented business people, which pushes doctors into a defensive stance. They see themselves as victims of a system that forces them to act against their ethical principles.

Digitalisation as a threat to the doctor-patient relationship

Another key factor contributing to the victim role is the ongoing digitalisation of the healthcare system. A large proportion of the medical profession sees digitalisation as a threat to the traditional doctor-patient relationship, which is based on personal contact and empathy. The introduction of electronic health records, telemedicine and digital means of communication are perceived as an alienation from personal, interpersonal interaction.

This fear of digitalisation is closely linked to the fear of losing control. Doctors are used to having sovereignty over the diagnosis and treatment process. Digitalisation is perceived as an encroachment on this autonomy, as it fundamentally changes the way medical information is collected, processed and used. This change creates a sense of threat to professional identity as it challenges the traditional practices that have been considered standard for decades. Doctors thus feel trapped in a passive role in which they can only react rather than act.

Health policy guidelines as a threat to medical freedom

A third factor is that many doctors equate healthcare policy measures that regulate day-to-day practice with an attempt to restrict their professional freedom. For them, rules and regulations are bureaucratic burdens that restrict individual freedom of choice and reduce flexibility in dealing with patients. These regulations force doctors to adapt their practice management to external standards that do not correspond to their personal ideas of good medical practice.

This perception is rooted in a deep-seated fear of heteronomy and loss of authority. Doctors are conditioned in their training to make independent decisions and take responsibility in complex situations. Healthcare policy interventions are then an attack on this autonomy, as they restrict the freedom to make decisions and the ability to respond to patients individually. This feeling of powerlessness is reinforced by the frustration of working in a system that is perceived as rigid and inflexible.

Overwhelming patient demands and the feeling of incompetence

The demands and expectations of patients have increased considerably in recent years. Patients have become more informed and self-confident, leading them to question diagnoses, collect their own health data, demand specific treatments and expect detailed explanations. Many doctors find these demands overwhelming and unreasonable, as they feel they cannot fulfil the high expectations in terms of time alone.

This fear of being overwhelmed is closely linked to feelings of incompetence and failure. Doctors are under pressure to be perceived as infallible experts, which increases the fear of mistakes and failure. The inability to fulfil all patient expectations in a consultative, diagnostic and therapeutic sense creates a deep sense of inadequacy. This feeling is further reinforced by the social and media pressure to always perform perfectly. Doctors experience themselves as victims of exaggerated expectations that they cannot possibly fulfil.

The self-image of the doctor through the ages

A decisive factor that explains the victim role of doctors is the changing self-image of the profession. The role of the doctor has changed from a paternalistic healer who makes decisions in the best interests of the patient to a service provider who must respond to the wishes and needs of patients. This change in role, in addition to the mechanism described at the beginning, is perceived as a threat to the traditional medical identity and can lead to a crisis of self-image.

Consequently, this change is also associated with a fear of loss of identity. The changes actually require an adjustment of the self-image, which many doctors find difficult. The gap between the traditional role and modern expectations creates a sense of alienation as doctors are forced to find their way in an environment that contradicts their previous beliefs.

The dynamics of the victim role and the need for self-protection

The perception of victimhood is not only a reaction to external circumstances, but also a deep-rooted psychological need for self-protection. In a complex and ever-changing environment, the victim role offers a way to mask one’s own vulnerability and to distance oneself from the challenges of modern medicine. It serves as a protective mechanism to cope with the fears associated with insecurity and dissatisfaction.

In this way, the victim role makes it possible to externalise responsibility. By projecting blame for professional challenges and dissatisfaction onto external factors such as healthcare policy or patient expectations, doctors can avoid responsibility for their own feelings of inadequacy and failure. This dynamic protects self-esteem and provides an explanation for the difficulties they face without the need to confront their own fears and insecurities.

The impact on well-being and job satisfaction

The reasons described for the victimisation of doctors have a significant impact on their professional well-being and satisfaction. The constant perception of being trapped in a passive role leads to a feeling of alienation from one’s own work. This alienation then manifests itself in the form of burnout, emotional exhaustion and a negative attitude towards work.

This dynamic is closely linked to the inability to recognise and articulate one’s own needs and desires. The role of the doctor is traditionally characterised by a high degree of self-sacrifice and dedication, which makes it difficult to perceive one’s own limits. The inability to respect these boundaries and take care of one’s own well-being reinforces the feeling of being a victim and leads to a vicious circle of excessive demands and frustration.

The challenge of self-reflection and the fear of change

Another aspect that contributes to the victim role is the difficulty of coming to terms with one’s own fears and insecurities. This would require a high degree of self-reflection and a willingness to change. However, many doctors find such self-reflection threatening, as it has the potential to challenge existing beliefs and behavioural patterns.

Such a fear of change is always closely linked to a fear of the unknown. Change requires a willingness to abandon familiar patterns and break new ground, which is associated with uncertainty and a feeling of vulnerability. The victim role offers a way to escape this uncertainty by providing a stable, albeit dissatisfied, position that preserves the status quo. This dynamic makes it difficult to access new perspectives and solutions that could improve the situation.

Conclusion

The perception of the victim role among doctors in private practice has various causes, which lie in the confrontation with business, technological, political and social challenges. These dynamics are closely linked to fears of loss of identity, loss of control and incompetence, which are exacerbated by changing conditions in the healthcare sector. Understanding these mechanisms provides valuable insights into the challenges facing physicians today and how deep-rooted beliefs and fears influence their professional perceptions and satisfaction.

Confronting the victim role is a challenge that requires both personal and professional growth. Reflecting on personal dynamics can be a first step towards understanding the victim role and gaining new perspectives that enable positive change in dealing with the challenges of modern healthcare.