“Olivia B. often lies awake in bed at night, her mind racing. She goes over everything again and again, step by step: the conversation with a patient, discussions with colleagues, initial treatment steps, potential alternative diagnoses. Did she miss something? Did she truly listen to the patient? Did she forget anything? Did she do everything correctly? She lives in constant fear of making a mistake.
Olivia B. is 32 years old and has been a physician in residency training since 2021. She works in the emergency department of a hospital in a large German city. (Her name has been changed; she wishes to remain anonymous.) She is specializing in neurology while also pursuing training in emergency medicine. Her daily work life is defined by stress, rapid-fire actions, numerous decisions, and immense responsibility.
She says she often enjoys her job, despite the high stress levels—but the day-to-day reality is grueling. Some weeks, she travels through the city in an emergency response vehicle; other weeks, she works shifts at the hospital. There is never a moment to complete even a single task without interruption. During her shifts in the emergency department, her phone rings incessantly. Someone always needs something from her. "These days, I don't even interrupt a trip to the restroom to answer a call," she says. It wasn't always this way.
For her, work is a state of constant stress. By the end of a shift—often after several hours of overtime—she heads home with her ears ringing. "You’re left with the feeling that you never have enough time for your patients." "There’s always an underlying fear of missing or overlooking something, because you have so much on your mind all at once."
At work, she manages to push this fear aside—"otherwise, I wouldn't be able to do my job at all"—but once the stress subsides, her thoughts begin to spiral: the fear of being responsible for a patient’s condition worsening—or, in the worst-case scenario, being to blame for someone’s death.
Laura Dalhaus is familiar with many such accounts. The fear of making mistakes, says the general practitioner—who is based in the Münsterland region and frequently advocates for a fairer healthcare system—stems from a complex set of issues. First, there are the structural conditions: the relentless pace, the lack of time, and the constant overtime—all of which are the responsibility of policymakers. However, patients and doctors also contribute to these dire circumstances. The core problem lies in the expectations held by both sides. The image of the doctor as an "infallible god in a white coat" still persists, even though it is simply impossible to avoid mistakes entirely.
"My job is to make sure I don't make any mistakes." Marie S. recently heard a colleague say this. The 33-year-old works as a physician at a general practice in a large city in southern Germany. She, too, wishes to remain anonymous; the risk of damaging her own reputation—or that of her practice—is too great, as the prevailing ethos among medical professionals is that mistakes must never happen. "Obviously, no one sets out to harm anyone," S. says, "but it happens nonetheless." There is no genuine "culture of error" within the medical profession. From the very beginning of their training, doctors are confronted with the expectation that they must be infallible—and are made aware of the potential legal consequences should they prove fallible.
"During medical school, we were constantly told: 'As doctors, you’re always one foot in prison,'" she says. S. says, "Naturally, that creates an immense amount of pressure." In her day-to-day work, the danger is very real: patients frequently threaten to sue her. She finds this extremely frustrating, often thinking, "I’m trying to help you, and yet you want to sue me." For any physician, the fear of ending up in court—and potentially losing one’s medical license, and with it one’s livelihood—is always a factor. So far, S. has not actually been reported or sued.
Laura Dalhaus, however, has experienced this firsthand. She was recently reported for negligent homicide. While the outcome was favorable for her, she describes it as "a truly terrible experience." She feels that threats of lawsuits from patients have become more frequent, with patients increasingly attempting to shift responsibility away from themselves. In a world where more and more people "refuse to take even a single cent’s worth of responsibility for themselves," the fear of being blamed has become a very real concern, Dalhaus says. The entire burden of responsibility for an individual’s health is placed on the doctors. "But we don’t have a crystal ball, either," she notes.
Physicians can only arrive at potential diagnoses using the tools at their disposal—all while operating within the constraints of economic efficiency. "I can’t just send a patient for an MRI without a clear medical indication," Dalhaus explains. Medicine is not as straightforward as one might wish; it operates based on probabilities. The basis for determining probabilities—such as the likelihood of a particular diagnosis—lies in a patient’s medical history, a physical examination, and a rational diagnostic approach. Yet, inevitably, there are patients who fall outside these statistical probabilities. The problem is that no one seems willing to accept this anymore. "That makes this job extremely difficult these days," she says. Many treatments are performed solely to preempt potential lawsuits.
Marie S. describes the situation in similar terms. "With some patients, it’s immediately clear what’s going on. With others, it simply isn’t," she explains. Many patients fail to understand—or forgive—the fact that doctors, too, face inherent limitations, whether in terms of knowledge or time. "We carry such a heavy burden of responsibility. The fact that patients themselves also bear some responsibility is often overlooked," she notes. When patients accuse her of not taking them seriously or downplaying their symptoms—or when they disparage other doctors—she feels a sense of utter despair: "What more am I supposed to do?" There always has to be someone to blame; if no one is readily apparent, one is sought out.
Marie S. feels this pressure every single day. The question keeps coming back: "Is this my fault?" As she cycles home after work, her thoughts begin to race. Riding through the city from her practice, her mind remains entirely occupied with her patients. Do they realize that she carries all of this home with her? That she spends her evenings on the sofa researching cases, consulting medical textbooks, reaching out to colleagues, and constantly turning these matters over in her mind? That she struggles to fall asleep because she’s caught in a cycle of rumination? That it’s the very first thing on her mind when she wakes up?
On some days, she manages to switch off; on others, it’s much harder. Cycling helps—as does being out in nature and talking on the phone with her best friend, who is also a physician. Olivia B. employs similar strategies. She engages in a great deal of endurance exercise, pushing herself to the point of exhaustion to clear her head. Strategies like these are necessary to endure the job, says B. She notes that among her colleagues, the pressure often finds other outlets—ranging from substance abuse to eating disorders.
According to a WHO study from last year, which surveyed more than 90,000 doctors and nurses across 29 countries—including all EU member states, Iceland, and Norway—more than three percent of physicians meet the criteria for alcohol dependence. One in three shows signs of depression or an anxiety disorder, and more than ten percent have experienced suicidal thoughts. Younger staff and women were particularly affected. Overall, doctors and nurses are five times more likely to exhibit symptoms of depression than the general population (32 percent compared to six percent). The WHO describes this as the largest study to date on the mental health of healthcare professionals in Europe.
"The results are alarming, but unfortunately, they confirm our fears," says Petra Beschoner, a specialist in psychiatry, psychotherapy, and psychosomatic medicine, medical director of the Bad Saulgau acute-care clinic, and an expert on the mental health of healthcare personnel. She explains that there are several reasons why doctors, in particular, are at such high risk—including heavy workloads driven by long hours and shift work, the expectations of patients, and the frequent threat of lawsuits.
Another fundamental issue is the near-total lack of systematic support for physicians. "I began researching the mental health of doctors as early as the early 2000s. Very little has changed since then," she says. "The subject remains highly stigmatized among doctors—even within the psychiatric professional community itself." For the image of the "demigod in a white coat" persists—even among doctors themselves. Weakness, fallibility, and—by extension—self-care are not factored into the equation. The prevailing attitude is: if the job is too tough, you’re just too weak.
Furthermore, many doctors define themselves entirely by their profession. "You aren't just a doctor from nine to five; you are one all the time—it’s who you are as a person," says Beschoner. This self-perception intensifies the pressure to be infallible. Doctors often internalize rigid standards and a drive for self-sacrifice, creating an immense internal pressure to perform. This makes them particularly prone to pushing past their own limits. "If I expect myself to be perfect at all times, I risk falling into unhealthy, controlling behaviors," she explains. According to the psychiatrist, doctors tend to resist accepting help; they find it difficult to shift into the role of a patient or someone in need of support. A doctor cannot simply go to a colleague and admit that they are struggling with their mental health.
Beschoner fears that, unless there is a fundamental change within the system, even more doctors will leave the profession for other fields—in which case, training new generations of physicians will be to no avail.
Olivia B. likes her job, despite everything. But whether she would choose this path again? "No," she says. Sometimes she dreams of a way out of it all: "My Plan B: opening a café." She pauses briefly. "But then again, maybe not. I don’t think I could ever work a job again that involves dealing with people."
Guilt?” [1]
1. "Mein Job: keine Fehler machen": Viele Ärzte leiden unter der ständigen Angst, Fehler zu machen. Das liegt auch am Anspruch der Patienten. Frankfurter Allgemeine Zeitung; Frankfurt. 14 Aug 2026: 9. Von Louise Otterbein
Komentarų nėra:
Rašyti komentarą