by Dr.Harald Wiesendanger– Klartext
What the leading media are hiding
Anyone who visits a therapy camp run by the Auswege Foundation /Ways Out Charity embarks on a journey through time: They enter the healing place of the future – one where many chronically stressed people are not only helped more effectively but also more humanely and more satisfactorily for everyone involved than in the “hospital” that is expected of patients by the pharma-heavy, technophile, profit-oriented conventional medicine.
It’s trivial things that obscure the view. By definition, a clinic is a facility in which damage to health is diagnosed, cured, or alleviated through medical, therapeutic, and nursing assistance. In this sense, we have long been running a clinic with our camps, and a mobile one at that: In certain calendar weeks, we open them for a short while, look after patients as inpatients, hand over the key at the end, pay our hosts for rent and meals, free of any further commitments – and open them again weeks or months later elsewhere, whenever enough qualified helpers from our therapist network can take the time for voluntary work. Assuming these camps eventually took place at a permanent location, they got a permanent home that stayed open all year round: what would they lack for a full-fledged clinic?
– So far, no diagnostics have been carried out in the “Auswege” (“Way Out”) camps; the range of therapies offered is limited; no apparatuses are available; there is no laboratory; Care, rehabilitation, aftercare, and prevention are lacking. But all of this could be integrated or ensured in close cooperation with practices, clinics, and services in the vicinity.
– So far, therapists have traveled for eight to nine days, after which they return to their homes. A permanent clinic operation would have to offer them accommodation and practice rooms or create incentives to settle in the immediate vicinity.
– A clinic incurs costs that our camps are spared: for the purchase of suitable real estate; for conversion, renovation, and furnishing for the intended purpose; for ongoing operations (electricity, water, heating; insurance, taxes and duties; maintenance, repairs); for therapists, nurses, and other staff – such as secretaries, caretakers, gardeners, cleaners, kitchen helpers, craftsmen, childcare workers, etc. – most of whom could no longer work on a voluntary basis but would have to rely on a steady income.
If the associated organizational, architectural, and financing problems were solved, the “Auswege” camps could easily be transformed into a clinic that has many advantages over conventional hospitals:
1. It would be a holistic clinic that not only eliminates manifest symptoms and their organic causes but also wants to restore “health” in a comprehensive sense, which the World Health Organization (WHO) wisely defined in its constitution as early as 1946 as a “state of complete physical, mental and social well-being.” It’s not just about curing; it’s about healing, not just about freedom from symptoms, but about being healthy.
2. A building that causes anxiety hinders healing processes. The “Auswege” clinic would be a place to feel good: outside, idyllic nature far away from urban noise and smog, from dreary neighborhoods, from asphalt and concrete deserts; Inside, bright colors, organic shapes, warm materials, natural light, pleasant smells, lots of pictures on the walls, plants everywhere. Because an aesthetic ambiance is healing. Instead of the dreaded hospital food, which the Swiss political scientist and health economist Gerhard Kocher deride as a “form of active euthanasia” (1), tasty, wholesome, freshly prepared food of organic quality is offered.
Functional, cold, efficiency-optimized: the design and furnishings of modern hospitals reveal a lot about the human image of the operator.
3. It would be a place of understanding. In order for patients to be open to what is on offer and willing to participate, they need to be able to see themselves as part of a meaningful whole. Why asks the former President of the Berlin Medical Association (1987-1999) and member of the “Auswege” Advisory Board Ellis Huber, “does the already long hospital day begin with waking up and washing at dawn, does breakfast come hours later, and supper well before the sandman time? Why does the professor have so little time during the rounds, and why does the young assistant doctor explain the forthcoming operation in medical jargon?” (2) The health economist Gerhard Kocher etched: “Breakfast at 6, lunch at 11, dinner at 5 – who still doubts that our hospitals are ahead of their time?” (3)
In “Way Out” camps, procedures and rules are transparent; they are explained and justified beforehand and during the stay. They are always subject to scrutiny and critical feedback from patients and employees. They are constantly being reconsidered and modified if necessary. Therapies are not just carried out but explained – and clearly, without technical jargon; not only on pages of information sheets, which serve less to educate the patient than to provide legal protection for the clinic but in a wealth of detail that the entire stay in the clinic would not be sufficient to carefully, critically understand and check.
4. The “way out” clinic would be a human home, a convalescent home, not a “hospital”: not a “building where sick people are generally given two kinds of treatment – medical by the doctor and human by the staff,” as the satirist Ambrose Bierce quipped. With us, those seeking help do not feel reduced to a patient role, which is only about their symptoms, functional impairments, and organic defects; they see themselves as accepted individuals with their unique history, particular circumstances, characteristics, needs, worries, and fears. You would be respected. “Human dignity is inviolable” guarantees Article 1 of the Basic Law, as far as we know, without the addition “unless he has to go to the hospital.” Our therapists don’t take care of “the atrophic kidney from room 13” but of a whole person.
5. It would be a place of intimacy. The practitioners are not strangers. In profile texts sent in advance, in introductory events, all therapists introduce themselves, describe their path through life, and explain their qualifications, main areas of practice, and approach. Then they allow themselves to be questioned about them. Reference persons stay the same, as is the case with shift work in hospitals, but remain with those seeking help from the first to the last day. You don’t only see them at official appointments; from morning to night, they remain part of the action: in morning yoga, at the breakfast table, on a hike together, in the queue at the food buffet, and chatting during breaks.
6. Trust takes time. It is prevented and destroyed in the case of those seeking help, which is interrupted by their doctor after an average of 15 seconds when they want to describe their problems and suffering. (4) That is why “way out” camps are places of “speaking” and “hearing” medicine, where no one looks impatiently at the clock and brusquely breaks off a dialogue before it has really started.
7. As in holiday paradises, so in “escape” camps, when too many people seek the magic of a place, it evaporates. Instead of hundreds living next to each other in huge buildings spread over different floors and wards, a maximum of two dozen patients and their relatives are brought together in moderated healing groups in “way out” camps. In such manageable social units, they always find contacts who can listen, entertain, comfort, change their minds, and encourage them. Forming such collectives in the context of a hospital operation represents an organizational challenge that can definitely be mastered.
8. It would offer connecting rituals that make the transition from/return to everyday life easier, provide security, and promote togetherness: from welcoming and farewell ceremonies to singing, reading, dancing, drumming, and playing together in the daily “morning circle,” which after breakfast, and meditating together at the end of the lunch break until the evening discussion round after a film screening, a workshop, a lecture.
9. The “Ways Out” clinic would give those seeking help the greatest possible freedom. Patients usually experience inpatient accommodation as a drastic restriction of their self-determination. It is determined over their heads who does what with them, when, and where; they are told what to do and what not to do. In our camps, on the other hand, therapies and therapists can be chosen based on detailed prior information and explanatory discussions, trusting in the responsible citizen in the patient. Appointments are not dictated by the practitioner but are agreed with him. Participants can organize their free time between appointments as they see fit, be it indoors or outside.
10. It would be a systemic place where help-seekers are not cut off from their familiar social network and looked after in isolation but with people closest to them. Not only at fixed visiting times but always welcome companions, children, and parents, they live in the house and are included in consultations, therapies, and all other camp activities. Your information is essential; your participation is indispensable. They, too, are advised and treated.
11. She would be in a place of loving care. There, helpers not only carry out any measures professionally cool, mercilessly purposeful, profit-maximizing, and always following the guidelines – they pay attention, sympathy, and care. “The future-oriented hospital must allow for a special degree of community, humanity, and charity,” emphasizes Ellis Huber. (5) Nursing, caring for and looking after the sick and disabled, would not be an inferior, secondary appendage to the “actual” therapy, but its integral, indispensable part. The human closeness that is given and felt “provides security and thus something from which one can draw strength again,” as one of the most well-known advocates of “loving medicine” emphasizes, Dietrich Grönemeyer, Professor of Radiology and Microtherapy at the university Witten/Herdecke. (6) Love heals.
12. It would be a place of threefold community: Those seeking help are encouraged to approach one another, to open up to one another, to exchange ideas with them, to spend time together, to listen to one another, to share in the fate of others, to help. The therapists do not stand above them in a know-it-all and authoritarian manner but as friendly, benevolent companions at their side. The helpers form a non-hierarchical team based on mutual respect. Nobody finds it embarrassing to say “du” to each other.
Warm-hearted, loving, and human, the “Auswege Klinik” would be a place of holistic healing and healing..
13. It would be a meaningful place. Here those seeking help begin to no longer see the injustice of a blind fate at work in their illness, with which they have to grapple bitterly – but to see it as an opportunity for inner growth, as a door opener to a more conscious life with new perspectives.
14. The “Ways Out” clinic would be a place of fulfilled helping. All team members feel equally respected across status boundaries. Nobody is more important. Everyone is heard with assessments, suggestions, and criticism. Different experiences and competencies are equally intertwined. It is decided together. Authority is based on competence, experience, and better arguments, not on positions and academic merits.
There are no senior and junior doctors here, no bosses and subordinates, and no professionals over laypeople. The working atmosphere is correspondingly relaxed, harmonious, trusting, and cooperative. Nobody needs to feel overwhelmed: Anyone who needs a break can include breaks in their appointment lists and withdraw for several hours or a whole day.
Helpers can devote themselves fully to their real task: serving patients; they are largely relieved of complex documentation obligations and completely relieved of organizational processes, administration, and accounting routines. “Way out” camps are free of everything from which, according to surveys, two-thirds of all clinicians and half of all nursing staff suffer: too much bureaucracy, too little decision-making authority, lack of time, pressure to perform, excessive demands, bad working atmosphere, lack of recognition. (7)
Exhausted nurse, stressed doctor: Chronic overstrain as an occupational risk in modern hospitals.
Whenever doctors joined our teams of helpers, they enjoyed the “way out” contrast program to their usual everyday work – as the specialist Dr. Gisa Gerstenberg in autumn 2022. “It was a moving and enriching experience for me! I was particularly impressed by the work setting: the opportunity to live together in such a humanely simple way that an exchange, therapy, and healing became possible at any moment – and all of this with the greatest possible self-determination – who works with whom/how long/with what content – in peace and freedom. This was a great gift for me. And an opportunity to reflect on everything that makes me feel restricted in our healthcare system. I would very much like to continue to immerse myself in this wonderful and refreshing community of people.”
15. It would be a pleasant place. Humor helps the healing – not through the assembly line production of jokes, but as a form of human understanding and dealing with one another that defies the seriousness of the situation without belittling it. Humor is good for helpers and those seeking help, in the sense of the proverbial talent of still being able to laugh: the inadequacy of the world, of fellow human beings and oneself, of facing everyday difficulties and mishaps with cheerful composure. (8th)
16. No age is too modern to create a place of mercy. Furthermore, as with all our camps since 2007, the “Auswege” clinic would remain a charitable institution: As before, poor people seeking help would be given advice and treatment free of charge, if necessary, even accommodated and fed free of charge. We could afford it if we received sufficient donations – and if the fulfillment of helping is more important to all those involved than maximizing income.
What kind of “optimization” do clinics need?
Do we really need new types of hospitals of this kind? After all, 83 percent of all those receiving inpatient treatment said they were satisfied with the medical care there, 82 percent with the nursing care, 79 percent with the organization and service; 82 percent would recommend their hospital to others: This is the result of the interim analysis of a mammoth study that has been running since November 2011, in which more than 1.5 million people with health insurance have been surveyed nationwide following a stay in the hospital. (9)
But how significant is such praise? Satisfied is someone whose expectations are met or exceeded. Because the majority of patients anticipate the worst before hospitalization, they are easy to please and pleasantly surprised. Right from the start, most of them don’t expect more than they have learned to expect from their previous contacts with conventional medicine: that defects in the body’s machinery will be identified and repaired there. How many realize what healing means, that it matters, and what would be necessary to achieve this goal?
However, the “hospital of the future” is not only dreamed of within the Auswege Foundation but has been dreamed of everywhere in our healthcare system for a long time: not because of rediscovered humanism and a broad trend reversal towards holistic medicine, but because of material constraints. In the face of skyrocketing costs for therapies, techniques, operations, and staff, clinics feel compelled to switch from a fiscal, tax-financed system to a commercial one in their struggle to survive. With this in mind, it is crucial to “optimize” structures, processes, and results.
Professional “quality management,” which has recently become the magic word in our healthcare system, should help with this. To ensure that practices and clinics offer better medicine, the legislature has commissioned institutes, set up committees, issued guidelines, made regulations binding, adapted the Social Security Code, and considered a compulsory certification.
The focus is on factors such as organizational processes, technical equipment, the level of training and further education of the staff, documentation, infection and hygiene “management,” safety, fire protection, occupational safety, billing behavior, drug consumption, number of measures carried out, procurement of equipment, the potential for rationalization, profitability.
The “hospital of the future,” as envisioned by business and technological “optimizers,” is paperless, creates, archives, and sends reports electronically, creates online dictaphones and mobile operating tables, computerizes patient admissions and anamnesis, fee collection and the processing of insurance claims, even “plans” in advance “the number of necessary doctor/patient contacts” (10), introduces laboratory and radiology information systems, relies on “mobile computing” and “hospital engineering”.
Then only the patient and the clinic staff have to be “optimized” so that they actually find the quality managed in this way to be helpful and healing, happily fit in, and appreciate “optimized” as optimal.
In such a reformed healthcare system, the therapist is the better; the more efficiently he knows how to use ever better machines and software – and the person seeking help, the less demanding he appreciates a superficial customer orientation instead of real care, which makes him a consumer and his health a commodity.
It is not an “alternative” outsider who denounces these undesirable developments, but rather the President of the German Medical Association, Frank Ulrich Montgomery: “The economization is progressing unabated. This is becoming a dangerous trend,” he warned at the opening of the 116th German Doctors’ Day in Hanover in May 2013. “In the hospital, economic performance is given a higher priority than medical performance, the quality of patient care, and the humanity in the services of general interest for the patients entrusted to us.” (11)
“Healthcare is more than a branch of the economy” — “Economic efficiency thinking endangers humanity.”
This type of health care reform is undoubtedly the best gold mine for management consultants, IT service providers, software developers, and certifiers, which is why the “quality offensive” (12) proclaimed by the federal government in the coalition agreement of November 2013 is being driven forward and dominated primarily by actors whose business Interests satisfied to the maximum – by financial beneficiaries of the “optimization revolution.” (13) Under her opinion leadership, priorities have grotesquely shifted. Starting from those affected, “result quality” would definitely have priority: What kind of clinic is most likely to make patients well again – and create the most satisfying, fulfilling working conditions possible for those who help?
A humane hospital reform would have to be preceded by a cultural reform that thinks and plans changes from the perspective of the people involved: what needs to be done to make them feel better? Above all, structures and processes would have to be optimized as a result. The propagandists of “optimization,” on the other hand, are concerned with the question: How do we get those seeking healing and those healing to find structures and processes that are optimal from a business and technological point of view – and how do we get political decision-makers and clinic operators to pay dearly for this?
It would be easy to determine what is actually and first and foremost important when it comes to medical quality: through visits to our therapy camps. “Quality managers” are not to be found there, but there is plenty of quality.
And that’s why two weeks of “way out” camp clinic per year are basically far too little. “Why shouldn’t such health camps run throughout the year at some point?” asks Dr. Johannes Engesser, a doctor specializing in general medicine and naturopathic treatment, after immersing himself in what was happening at the camp for three days – “always with different doctors and therapists who can make their potential available, always in other suitable places, always with other patients, as often and as often as long as they need it?”
(Harald Wiesendanger)
“In our high-tech hospital world, we have to recognize that the technical perfection of a heart operation does not solve the problems that go to the heart”-Ellis Huber
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Remarks
1 Gerhard Kocher: Caution, medicine! 1555 aphorisms and food for thought, Bern, 3rd edition 2006.
2 Ellis Huber: Love instead of Valium – concepts for a new health care reform, Munich 1993, updated and expanded paperback edition 1995, p. 91 f.
3 in Caution, medicine!, loc.cit.
4 According to Journal of the American Medical Association 298/2007, p. 993.
5 In an interview with Weleda Nachrichten 216/1999, p. 6 ff.: “The hospital of the future – from survival space to living space”, p. 11 there.
6 In his article “A loving medicine is not a utopia”, in Arnulf Thiede/Heinz-Jochen Gassel (eds.): Hospital of the Future, Heidelberg 2006, pp. 81-87, p. 82 there.
7 Katharina Janus/Volker E. Amelung et al.: “German physicians’ on strike’ – Shedding light on the roots of physician dissatisfaction”, Health Policy 82 (3) 2007, pp. 357-365; Werner Schweidtmann: “Job satisfaction and identity among doctors and nursing staff in hospitals”, Prevention 21 (4) 1998, pp. 120-123; F.W. Schwartz/P. Angerer (ed.): Working conditions and well-being of doctors – findings and interventions, Cologne 2010; Bettina Dilcher/Lutz Hammerschlag (eds.): Everyday hospital life and job satisfaction, 2nd edition Wiesbaden 2013.
8 This is how Duden defines it: The dictionary of origins, Mannheim 1989, p. 294.
9 Achim Kleinfeld/Marcel Weigand and others: “Patient perspectives as an element of hospital quality assurance”, BARMER GEK Healthcare News 2014, pp. 76-89.
10 According to the European Health Forum Gastein (EHFG), the leading health policy conference for experts and decision-makers in the European Union: “The hospital of the future: counting beds was yesterday”, online here.
11 Press release from the German Medical Association: “116. German Doctors’ Day opened in Hanover”, online here.
12 Read online here.hier.
13 See, for example, the Hospital IT Journal 2/2007, p. 76 ff.: “Managers outline the hospital of the future”; www.behoerden-spiegel.de: “Hospital of the future”; www.hospital-engineering.org: “Hospital Engineering – Innovation paths for the hospital of the future”; www.behoerden-spiegel.de: Hospital Engineering Magazin 4/2014: Colossus hospital – strategies www.hospital-engineering.org for controlling a sluggish giant”; Elektronik Praxis Nov. 2012: “Blue Hospital – What the hospital of the future could look like”, online here.
14 Published in Berliner Ärzte 9/2002, can be read online here. hier. 15 can be read online here.hier.