Our clinics are threatened with collapse: Patients are in danger. People who work in the hospital, but also. psychologist dr Marion Koll-Krüsmann from a hotline for overwhelmed hospital staff sounds the alarm.
FOCUS online: When I recently visited my father in the hospital, I had to look forever for a doctor. Finally, I found a young woman sitting at a desk in despair with her hands over her head, saying to a nurse, “I’m the only doctor in the whole house, I don’t know how to do this…”
Marion Koll-Krüsmann: That is a typical situation that you experienced there and that perfectly describes the fact that our entire healthcare system is on the verge of collapse after years of economization. The prevailing feeling is a complete overstrain.
Such a doctor, as you have seen, has official responsibility, even more than pure nursing staff – and feels that she cannot live up to this responsibility for the lives of her patients. Of course she’s desperate.
You want to help these desperate employees with the association PSU Akut…
Koll-Krüsmann: Yes, by colleagues. Since Corona, we have had the helpline, a telephone number that people in the healthcare sector can call 12 hours a day if they feel they would benefit from support.
40 percent of the calls to us come from doctors. These are doctors who have chosen their profession because they want to heal people, and who despair because the general conditions no longer make it possible for them to do so. The human aspect also falls by the wayside. Many tell of being overwhelmed or of post-traumatic symptoms such as flashbacks or uncontrolled tremors.
What worries callers most?
Koll-Krüsmann: At the beginning of Corona, many were afraid of taking the virus home to their families. After that, there was above all a great deal of helplessness: Young men came to the ward who were fit and ended up dying from the breathing apparatus, and you didn’t yet know how to help them.
Today, the main focus is on chronic overload. A typical call comes from a young doctor who doesn’t get any rest in the evening and says: “I can’t keep up anymore. I can’t properly care for my patients. There are people who shouldn’t have died.”
And then, of course, there are serious events, such as a routine operation on a father with three small children, which has complications, and in the end the man is dead. It’s horrific, you can’t get used to it . You can only learn to deal with it better.
How can you help someone on the phone telling a story like this?
Koll-Krüsmann: The goal is to first listen and structure. This is where it helps when a colleague, not a psychologist, says: “That’s bad. I’ve had that too. You are not alone.” Then it is a matter of looking: What gives strength now? Who can help in the area? And we teach methods with which you can better differentiate yourself from what you have experienced.
How do they look?
Koll-Krüsmann: These can be after-work rituals. For example, that you imagine packing all your worries in little bags that you gradually put away on the way home. We humans cannot think of nothing. Especially not when it comes to distressing memories.
But we can try to put them on resubmission and thus break thought loops. For example, by imagining how I lovingly store difficult images in my head in an album and lock it in a safe. I can go back and get them out, but I can put them away.
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How could it happen that our healthcare system is so ailing?
Koll-Krüsmann: This is mainly due to the way the billing is done. It used to be that hospitals received a nursing fee for every day that a patient was there, regardless of the illness. As a result, many patients stayed in the hospital too long for the beds to be full.
Today, payment is based on the diagnosis. This means that the clinic now receives a fixed amount for an appendix, for example, no matter how long the patient is on the ward. This means that – as the doctors say – patients are discharged “bloody” because the bed is then free for the next person and money is earned again.
In addition, savings are made on staff. As a result, beds are scarce and care in emergency medicine is simply no longer guaranteed. This is of course an insane burden.
If you could change one thing about healthcare, what would it be?
Koll-Krüsmann: The financing of the institutions. The healthcare system must not be a profit-making machine. The actions of those responsible for the clinic are often criticized. However, they do not make decisions because they are of bad character, but because they have to meet specifications. We have nursing leaders who say: “I’m completely open to blackmail if a nurse says: ‘I’m not going to do the service, otherwise I’ll quit.'” Of course I would change that too: better pay for the nurses!
How is it in other countries?
Koll-Krüsmann: In Italy, for example, a distinction is made between care for the elderly and medical care in hospitals – only the latter is provided by nursing staff. Care for the elderly, such as feeding or washing, is carried out by relatives or – if they are not available – other patients. But that is by no means desirable for us.
In countries like Scandinavia, much more is done on an outpatient basis – even something like caesarean sections. We also have people who need acute medical help, but do not necessarily have to go to a hospital or the emergency room.
When I experienced the overloaded caregivers myself, I asked myself how I can help as a family member. I can’t pay a better salary.
Koll-Krüsmann: I think in the end it’s all about being friendly. And that you don’t take your frustration out on those who are still trying to turn things around. That’s happening more and more frequently. But they suffer themselves and work double shifts when a colleague is ill because they absolutely want it to work.
So be friendly, try not to ring the bell for every little thing, get your own tea and throw your displeasure in the suggestion box so that it gets where it’s supposed to get. And of course you can also campaign at the political level to improve the framework conditions in the healthcare system.
Can a gesture like a gift or a letter be a good idea?
Koll-Krüsmann: Writing a card is always good. A really experienced, older doctor once told me that in the first fall/winter of Corona, when so many were dying, he got a letter from grandchildren whose grandpa survived the disease – with pictures and all. The doctor reads this letter and starts crying. He himself was surprised and shocked at what came out of this gesture.
At the beginning of Corona, there was also clapping for the nursing staff…
Koll-Krüsmann: Yes, and it was well received at first. And then at some point it turned into cynicism: What’s with the gossip, that doesn’t help us at all. We need more staff, higher salaries and again and again: more staff.
Let’s imagine: A 17-year-old schoolgirl comes to you today and says: “I would like to be a nurse.” Is that your advice?
Koll-Krüsmann: I would say: “Do it! Be prepared for difficult moments to come. But I am of the firm opinion that it is a meaningful and fulfilling job despite everything. And get involved in making changes as much as you can.”
Do you think anything will change?
Koll-Krüsmann: Yes, I see tendencies that things are getting better. Or to put it another way: I can see that there is at least a genuine awareness of the problem. Now all you need is the courage to think very fundamentally about new concepts and not just tinker around on a small scale.
It would be important for the decision-makers to be people who have personally experienced everyday hospital life and know how it actually works. I think abolishing the diagnostic flat rates would be a good first step. But that doesn’t bring more staff either and that would be the most important thing at the moment. We will see whether in the end something that is absolutely necessary will really change.
What is your experience with our healthcare system? What have you experienced in clinics and medical practices? What are you upset about? And what would you like to say to Federal Health Minister Karl Lauterbach (SPD)? Write us! You can send your experiences to gesundheit@focus.de.
