Imagine trying to clear the snow from your driveway - while you're in the middle of an avalanche.
When a former classmate of mine recently took on a new position as "Senior Physician" in a geriatric hospital, this what essentially what he experienced. At least on an emotional level.
Maybe he should have been skeptical about how easy it had been to get the job. Maybe. But the clinic is located right where he lives. And Berlin's northern outskirts aren't exactly the middle of nowhere.
Still, "Who doesn't have a stressful job?" you might think. And of course there are plenty of people who've mastered the art of complaining.
But in his case the stats spoke for themselves.
Being responsible for 100 geriatric patients, with only one (language-barrier struggling) assistant helping you, is evidently more than just "stressful". It's an avalanche.
100 geriatric patients - many of them struggling with dementia - ultimately means it's not only them having a hard time remembering you. My classmate soon stopped trying to memorize names. Even his own.
He was juggling.
100 geriatric patients also means you'd need more than a day just to briefly visit all of them. That's the theory of course. In reality you spend your day running to wherever there's an emergency. Nothing rare within that age group.
The remaining time you spend writing doctor's report after doctor's report. Informing the patient's GP what you did medically, when you actually didn't have the time to do anything. So you even have to get creative.
And where does this leave us?
Luckily, in Germany extreme examples like this still are the exception. Although you can easily increase the odds by simply selecting more remotely located hospitals.
But in order to fully understand the issue, we need to look at the even bigger picture: Most societies are aging. Particularly the Western ones.
Take Japan for example. With a median age of around 48 years, it's the country with the oldest population (closely followed by Italy). And there's only one direction from here: On average there are 1.3 births per Japanese woman (with 2.1 being the "magic number" to keep a population stable).
Now if you think "48 years" doesn't sound that old, a few follow-up stats might help:
In Nigeria for instance, the median age is only 17 - with a striking 5.24 births per woman (yet even Nigeria's birth rate has been decreasing).
But more importantly, over 25 % of the Japanese population is 65 years or older. In comparison, less than 3 % of Nigerians fall into this age bracket.
Of course there's also the famous "But isn't 70 the new 60?" argument. And it's partially true. The overall lifespan has been increasing historically. However, it's easy to confuse the terms lifespan and healthspan.
It's really more the "number of relatively healthy years" (healthspan) most people want to increase.
Authors who've dug deep into that topic (see Attia's "Outlive") commonly report a simple conclusion: Even though a healthy lifestyle clearly prolongs life (and therefore also people's work and social life). Ultimately, people will still die from the same conditions. Just later.
Or in other words: On average a person dies 3 years after receiving a cancer diagnosis. With a healthy lifestyle, this cancer might develop significantly later in life. But even then, it's still going to be those 3 final cancerous years (on average, after diagnosis).
Same for my beloved grandaunt who was still literally wrestling with me when she was 70 (me still being a child at the time - just for the record). Undoubtedly, she was one of those so-called "best-agers". Yet, when she eventually turned 94, even she had to grapple with the defeating aftermath of a stroke.
All of this is to say: "Yes, 70 might be the new 60". But if a growing chunk of the population soon turns 80, this still puts a lot of strain on a country's healthcare system.
This is not supposed to be a downer. So please keep eating your veggies. The apple a day is still worth it and might actually keep the doctor away for a while. It just won't make you immortal. Apologies!
Moreover, we really want to acknowledge most doctors' workload reality.
So can doctors rise to the occasion? Well, it's tough.
According to numbers from the WHO, per 10,000 citizens there are currently 36.6 medical doctors in the European region, 24.5 in the region of the Americas, 20.9 in the Western Pacific region, 11.2 in the Eastern Mediterranean region, 7.7 in the South-East Asia region, and 2.9 in the African region.
Of course, with the right marketing and financial incentives, my classmate's geriatric clinic might be able to attract more foreign doctors. But that would obviously lead to even more brain drain effects in an already unequally distributed system.
And even if we assume the extreme geriatric example might have been partially due to solid mismanagement (my classmate quit soon after)...
And even if we consider ourselves "lucky" given the global comparison...
And even if we feel generally optimistic about the "Elon Musks of this world" eventually inventing a miraculous fountain of youth...
...Then the current average of a German GP only having 7.5 minutes per patient still speaks volumes (for now).
This does not only result in the whole doctor-patient interaction feeling rushed. It can also lead to detrimental health outcomes for the patient and a fragile mental health for physicians.
Ultimately, even a doctor's brain faces cognitive overload. Or as Stanford biologist Robert Sapolsky puts it:
"Make the frontal cortex work hard - a tough working-memory task, regulating social behavior, or making numerous decisions [...]. Immediately afterward performance on a different frontally dependent task declines. Likewise during multitasking" (see Sapolsky's "Behave").
So motivation alone just won't do it.
For the individual doctor this also has an additional, quite practical effect. It's simple:
If your workload is overwhelming on a daily basis, chances are high the first thing you're going to cut back on is the time you're willing to spend on your own (further) education.
This is understandable. Patients, colleagues, family, and friends should always come first (you pick the exact order).
Yet, medical knowledge is continuously evolving. Something that's been the widely accepted "gold standard" yesterday can be "malpractice" tomorrow.
And if politics remain slow in coming up with major workload improvements, modern medical education faces the challenge to at least get across more information in less time.
Because time has become the scarcest thing of your (work)life.
Continue with part 4 of our series to find out how short the half-life of medical knowledge has become.
Sebastian Szur is a writer and medical doctor. After completing his medical studies, he went into health-tech where he focused on refining diagnostic algorithms and communicating digital innovation. He's also worked at a clinic for internal medicine and psychosomatics studying the connection of mental and physical health. Writing has always been an essential part of his life. He's the Head of Medical Writing at Medudy.
You know that saying about a picture being worth a thousand words? Well, turns out those words can be pretty biased - who knew, right? The representation of diversity in medical illustrations is a critically important topic with the potential to revolutionize the healthcare system, particularly by empowering Black, Indigenous, and People of Color (BIPOC).
Being a teacher's son provides you with a masterclass in cheating. Everyone knew about my mum's golden rule: "I don't mind students trying to cheat. They just need to accept the consequences if I manage to bust them." And that she did a lot. At times it almost seemed like it had become a guilty pleasure of hers. Decades of practice had made her a detective someone like Columbo would have looked up to. At dinner she used to tell us about her latest "coup". Euphoria in her eyes. Victory in her voice. "Passing on a piece of paper... I mean please! Did he think I was born in the Stone Age?" Sometimes I wondered if they even had a chance. Seeing other people get burned on a daily basis, naturally I didn't even consider playing with fire. I was an eager-to-please student learning everything by heart. ...until Medical School. That's when things changed.