Germany's penchant for nonsense: How meaningless work makes us sick
Last May, Friedrich Merz called for more work. His Minister of Economic Affairs followed suit in July, and Holger Schäfer from the Institute of Science echoed this sentiment a few weeks ago. Now, a debate is raging about supposedly high rates of sick leave in Germany - the assumption being that employees frequently play hooky. However, high rates of absenteeism are a problem that goes hand in hand with increasingly unproductive and mindless work.
By Daniel Nuber
By Daniel Nuber
As a certified specialist in the health and social services sector, I'm doubly burdened: I have to grapple with absurd business and commercial procedures that very often lack both meaning and purpose, and I do so in a sector that's on its last legs. Despite the enthusiastic applause from celebrities and politicians during the pandemic, surprisingly, working conditions in the healthcare sector haven't improved. On the contrary: The burden on the shoulders of doctors, nurses, and administrative staff has been growing for years, along with the number of mindless, pointless tasks. An average of just under 15 sick days per employee is still very low compared to the frustration and psychological strain that obviously has to be endured not only in the medical field, which is the focus of this text. Merz, his predecessors, and his cronies are the accelerants who, with such ludicrous insinuations about excessive absenteeism, are undermining those who are still trying to somehow keep the politically destroyed system afloat.
15 sick days on average per employee is still very low compared to the frustration and psychological strain that is obviously not limited to the medical field, but which is the field I want to focus on in this text. During his time as Health Minister, Jens Spahn managed to keep health insurance premiums from rising. This went down well with voters. But nobody questioned how he did it - he forced the health insurance funds to use up their savings instead of offsetting rising costs with premium increases. This worked perfectly during his term, and afterwards he didn't care what happened - he was no longer responsible. Since he thankfully left office, premiums have had to keep rising, because not only are costs exploding, but reserves also need to be built up, which, of course, no longer exist. Consequences of this misguided policy? None whatsoever. Instead, he clowns around in the Bundestag and spouts nonsense on talk shows. The money he should have raised through premium increases during his ill-advised tenure as minister is now, of course, sorely missed. This still creates immense cost pressure in a healthcare system that is practically a form of socialism in a democratic country - there's a shortage of the easiest things, criticism of those in power is forbidden, and the authorities never have to take responsibility for mistakes, no matter how big or small, but enriching themselves is somehow acceptable (mask deals and such).
Now, you might think that this was a political game that had no noticeable effect on the general public - apart from the current premium increases. You would be wrong. The cost pressure on health insurance companies creates enormous cost pressure on healthcare providers because every opportunity is used to avoid paying for services rendered. For example: Patient A receives intensive care treatment for weeks. Everything is documented and verifiable in hundreds of pages of patient data. The bill for a high five-figure sum goes to his health insurance company, and they say: no, we don't believe it. Did A really need to be in intensive care for seven weeks? Did he really need a ventilator? Was the heart surgery truly necessary? Couldn't he have gotten better at his own expense in a hotel in Ibiza? Then the Medical Service comes crawling around, presenting itself as an independent expert body, but demanding proof of the treatments' necessity and questioning every word. This often ends in a legal battle that then has to go to court. None of the parties involved are to blame. The origin of this not uncommon process lies in massive political misjudgments that remain uncorrected to this day. Frustration is growing among the staff. You can guess who then has to prove that the therapies were medically indicated for patient A. That's right! The treating physician. While the patient has already been discharged or has died, the physician has to deal with expert opinions and statements - leaving them with no time to care for other patients. Doctors and nurses in hospitals spend more than half their working hours as clerks. Every little thing has to be written down, often multiple times; insurance companies want expert opinions, and so do the courts. It's incredibly frustrating. And frustration leads to depression in the long run, and that leads directly to sick leave. Why don't we simply introduce a system where health insurance companies and the Medical Service have to prove that the treatment wasn't necessary? They have all the treatment data and could easily do so. There's a reason they don't want to: they hope the practitioner will waive payment because the legal battle over costs is too much of a hassle. One of the damnedmany systemic errors.
A far greater problem, both operationally and economically, is the existence of pointless activities, which I can't even begin to describe as truly meaningless as they are and feel. A recent example from my work life: In hospitals, there are countless hazardous materials. Oxygen, corrosive substances, and so on, which can injure people or, if handled improperly, cause fires or even explosions. I completely understand that hazardous materials can't be stored in unlimited quantities on wards. What neither I nor anyone else I know understands is that inventory only needs to be taken once a year. Let's say your ward is only allowed ten oxygen cylinders. Today you count them--there are nine, hooray, everything's fine. Two days later, there are 26 cylinders. Because nobody has to count them anymore, let alone report them, there are absolutely no consequences. None whatsoever. Zero. Nada. So it's completely irrelevant that two days earlier you even had fewer than the permitted number. So why do we even count them? Don't think for a second that only obviously hazardous substances need to be recorded--that would be far too easy. It also has to be documented how many hand soaps are present and--no joke--what form they're in. Is it liquid soap? Or bar soap? Or is it remnant of Heisenberg's crystal meth? Nurses, hygiene officers, administrators, managers, and regulatory authorities are all involved in this ridiculous task. And it takes weeks because every single bottle, no matter how small, has to be meticulously recorded.
This isn't work. This is busywork. We have plenty of busywork--we could be sick for 30 days across the entire society and still be more productive if we replaced these purely busywork tasks with productive work. Want more examples? When you're admitted to a hospital as a patient, both a digital and a paper medical record are created for you. All treatments, findings, and documentation are entered digitally into the patient management system. Now, don't think for a second that that's enough. All (!) findings, letters, and other documents stored in this software are printed out after your discharge, placed in your paper file, then scanned and thrown away. I'm getting burnout just writing this.
I can even answer the question of why rationally: Because the software used for patient management is usually not a certified medical device and therefore significantly cheaper to purchase. Because it lacks certification, however, the digitally available examination data is treated as if it had never been performed. The hospital could prove that you were there, but if the necessity of treatment is questioned again and there's nothing in paper form, they'll claim the hospital didn't do anything for you and therefore didn't generate any billable services. Insane, right? Now imagine you've studied and trained for six, seven, or more years, only to end up spending a significant portion of your life printing out digital documents, scanning them, entering them into the same digital system, and then throwing them away. How can you not get sick? If you're wondering why the scanned documents can be stored in the same management system without any problems: because the scan proves their existence in paper form, and the paper form serves as the basis for billing.
But it doesn't stop there. Are you familiar with compliance? It's a great thing--and it creates even more jobs. Companies (whether in healthcare or elsewhere) invent regulations that the companies they work with then have to adhere to. This has real consequences in my industry, too. When we organize a training event with sponsors, each sponsor brings their own set of rules that we feel obligated to follow. This can include anything from ethical guidelines defining how we should interact with each other, to transparency regulations, all the way to ID checks for representatives who want to set up a booth at the event. Because it's always different, there's no standard. Company A wants ID checks, Company B doesn't. Company B wants gender-inclusive language on their flyers, while Company C absolutely doesn't want that, but would like a picture of Honecker on their flyers because he's still honorary chairman of the board. This is utter nonsense that accomplishes absolutely nothing - for anyone. But I know from personal experience that there are people who are incredibly...It's just a way for them to annoy other people with their own invented rules, people who depend on the money they receive for complying with those very rules. That's the only reason they do it. It's never productive or sensible - and that, too, is something that can be frustrating and even make you sick, precisely because it's completely arbitrary and pointless.
Complaint management also plays a major role in this job-related bingo game. These days, everyone complains about everything - especially in the healthcare sector, because the health insurance card is seen as access to an all-you-can-eat buffet. So, if Luise decides to go to the emergency room at 3:00 a.m. on a Saturday with her foot pain, which she's had for three weeks, then of course she has to be treated immediately. "It can't be," she'll later write in her Google reviews, "that I have to wait over eight hours!" And then, as she continues to rant, she's brushed off in two minutes by the doctor, who's only worked 23 hours and should therefore be fresh and motivated. Unbelievable! Because the hospital's compliance policy (there's that crap again) dictates it, this mental diarrhea has to be addressed properly. She's encouraged to contact the complaints department, and then her case will be reviewed. Luise does just that, because Luise is quick-witted and doesn't take any nonsense; after all, she's paying for the service. She then describes her ingrown toenail in great detail, which prompts the staff to consult with the doctors and nurses involved. Naturally, Luise then receives a lengthy apology email promising that such behavior won't happen again because it doesn't meet the hospital's quality standards. Are there any consequences? Of course not. If she shows up at the emergency room again with her little problem, she'll wait just as long and be dealt with just as quickly, because she simply doesn't belong there with her minor ailment. The only thing the clerks, doctors, and nurses have lost is their working time, which they then have to fill with more nonsense.
Luise may not be the sharpest tool in the shed, but she's a product of a systemic problem that extends far beyond just foot pain. The declining number of general practitioners and specialists in private practice, coupled with the difficulties in getting appointments, leads to hospitals being visited more often than necessary. After all, there's always a doctor available there. The problem is well-known, but it's not being addressed politically. Recruiting foreign specialists was supposed to solve it--but the reality is that Germany struggles with recognizing foreign qualifications and degrees. We've also devised a ridiculous procedure for this: A doctor who comes to us from outside the European Union is allowed to practice for a limited period. After that, they can't anymore. Then he has to painstakingly fight for his medical license and provide all sorts of documentation proving his knowledge and skills. In other words, for a period of one to two years, he poses no danger to humanity and is allowed to practice medicine. But once that period expires, he's suddenly dangerous and has to prove he isn't. What's the point of that?
These are just a few examples of the debilitating problems within the healthcare system. I'm optimistic that all sectors of our labor market contain similarly pointless jobs, leading primarily to employee burnout. We have no idea of the economic damage caused by our own regulations, inefficient processes, entitlement, and lack of direction. The average sick leave of approximately 15 working days per year, as denounced by Friedrich Merz, is the least of our society's and labor market's problems. Considering all the nonsense described--and, as I said, this is just a fraction of it--we can all be thankful that employees are typically absent for only three weeks.
28.01.26
©Daniel Nuber
In his book "Rust, Weed, and Rakija," Daniel Nuber describes his journey through the Balkans. He is also a certified specialist in the health and social services sector and works as an author, videographer, and photographer.
CLICK HERE FOR THE NEW BOOK
15 sick days on average per employee is still very low compared to the frustration and psychological strain that is obviously not limited to the medical field, but which is the field I want to focus on in this text. During his time as Health Minister, Jens Spahn managed to keep health insurance premiums from rising. This went down well with voters. But nobody questioned how he did it - he forced the health insurance funds to use up their savings instead of offsetting rising costs with premium increases. This worked perfectly during his term, and afterwards he didn't care what happened - he was no longer responsible. Since he thankfully left office, premiums have had to keep rising, because not only are costs exploding, but reserves also need to be built up, which, of course, no longer exist. Consequences of this misguided policy? None whatsoever. Instead, he clowns around in the Bundestag and spouts nonsense on talk shows. The money he should have raised through premium increases during his ill-advised tenure as minister is now, of course, sorely missed. This still creates immense cost pressure in a healthcare system that is practically a form of socialism in a democratic country - there's a shortage of the easiest things, criticism of those in power is forbidden, and the authorities never have to take responsibility for mistakes, no matter how big or small, but enriching themselves is somehow acceptable (mask deals and such).
Now, you might think that this was a political game that had no noticeable effect on the general public - apart from the current premium increases. You would be wrong. The cost pressure on health insurance companies creates enormous cost pressure on healthcare providers because every opportunity is used to avoid paying for services rendered. For example: Patient A receives intensive care treatment for weeks. Everything is documented and verifiable in hundreds of pages of patient data. The bill for a high five-figure sum goes to his health insurance company, and they say: no, we don't believe it. Did A really need to be in intensive care for seven weeks? Did he really need a ventilator? Was the heart surgery truly necessary? Couldn't he have gotten better at his own expense in a hotel in Ibiza? Then the Medical Service comes crawling around, presenting itself as an independent expert body, but demanding proof of the treatments' necessity and questioning every word. This often ends in a legal battle that then has to go to court. None of the parties involved are to blame. The origin of this not uncommon process lies in massive political misjudgments that remain uncorrected to this day. Frustration is growing among the staff. You can guess who then has to prove that the therapies were medically indicated for patient A. That's right! The treating physician. While the patient has already been discharged or has died, the physician has to deal with expert opinions and statements - leaving them with no time to care for other patients. Doctors and nurses in hospitals spend more than half their working hours as clerks. Every little thing has to be written down, often multiple times; insurance companies want expert opinions, and so do the courts. It's incredibly frustrating. And frustration leads to depression in the long run, and that leads directly to sick leave. Why don't we simply introduce a system where health insurance companies and the Medical Service have to prove that the treatment wasn't necessary? They have all the treatment data and could easily do so. There's a reason they don't want to: they hope the practitioner will waive payment because the legal battle over costs is too much of a hassle. One of the damnedmany systemic errors.
A far greater problem, both operationally and economically, is the existence of pointless activities, which I can't even begin to describe as truly meaningless as they are and feel. A recent example from my work life: In hospitals, there are countless hazardous materials. Oxygen, corrosive substances, and so on, which can injure people or, if handled improperly, cause fires or even explosions. I completely understand that hazardous materials can't be stored in unlimited quantities on wards. What neither I nor anyone else I know understands is that inventory only needs to be taken once a year. Let's say your ward is only allowed ten oxygen cylinders. Today you count them--there are nine, hooray, everything's fine. Two days later, there are 26 cylinders. Because nobody has to count them anymore, let alone report them, there are absolutely no consequences. None whatsoever. Zero. Nada. So it's completely irrelevant that two days earlier you even had fewer than the permitted number. So why do we even count them? Don't think for a second that only obviously hazardous substances need to be recorded--that would be far too easy. It also has to be documented how many hand soaps are present and--no joke--what form they're in. Is it liquid soap? Or bar soap? Or is it remnant of Heisenberg's crystal meth? Nurses, hygiene officers, administrators, managers, and regulatory authorities are all involved in this ridiculous task. And it takes weeks because every single bottle, no matter how small, has to be meticulously recorded.
This isn't work. This is busywork. We have plenty of busywork--we could be sick for 30 days across the entire society and still be more productive if we replaced these purely busywork tasks with productive work. Want more examples? When you're admitted to a hospital as a patient, both a digital and a paper medical record are created for you. All treatments, findings, and documentation are entered digitally into the patient management system. Now, don't think for a second that that's enough. All (!) findings, letters, and other documents stored in this software are printed out after your discharge, placed in your paper file, then scanned and thrown away. I'm getting burnout just writing this.
I can even answer the question of why rationally: Because the software used for patient management is usually not a certified medical device and therefore significantly cheaper to purchase. Because it lacks certification, however, the digitally available examination data is treated as if it had never been performed. The hospital could prove that you were there, but if the necessity of treatment is questioned again and there's nothing in paper form, they'll claim the hospital didn't do anything for you and therefore didn't generate any billable services. Insane, right? Now imagine you've studied and trained for six, seven, or more years, only to end up spending a significant portion of your life printing out digital documents, scanning them, entering them into the same digital system, and then throwing them away. How can you not get sick? If you're wondering why the scanned documents can be stored in the same management system without any problems: because the scan proves their existence in paper form, and the paper form serves as the basis for billing.
But it doesn't stop there. Are you familiar with compliance? It's a great thing--and it creates even more jobs. Companies (whether in healthcare or elsewhere) invent regulations that the companies they work with then have to adhere to. This has real consequences in my industry, too. When we organize a training event with sponsors, each sponsor brings their own set of rules that we feel obligated to follow. This can include anything from ethical guidelines defining how we should interact with each other, to transparency regulations, all the way to ID checks for representatives who want to set up a booth at the event. Because it's always different, there's no standard. Company A wants ID checks, Company B doesn't. Company B wants gender-inclusive language on their flyers, while Company C absolutely doesn't want that, but would like a picture of Honecker on their flyers because he's still honorary chairman of the board. This is utter nonsense that accomplishes absolutely nothing - for anyone. But I know from personal experience that there are people who are incredibly...It's just a way for them to annoy other people with their own invented rules, people who depend on the money they receive for complying with those very rules. That's the only reason they do it. It's never productive or sensible - and that, too, is something that can be frustrating and even make you sick, precisely because it's completely arbitrary and pointless.
Complaint management also plays a major role in this job-related bingo game. These days, everyone complains about everything - especially in the healthcare sector, because the health insurance card is seen as access to an all-you-can-eat buffet. So, if Luise decides to go to the emergency room at 3:00 a.m. on a Saturday with her foot pain, which she's had for three weeks, then of course she has to be treated immediately. "It can't be," she'll later write in her Google reviews, "that I have to wait over eight hours!" And then, as she continues to rant, she's brushed off in two minutes by the doctor, who's only worked 23 hours and should therefore be fresh and motivated. Unbelievable! Because the hospital's compliance policy (there's that crap again) dictates it, this mental diarrhea has to be addressed properly. She's encouraged to contact the complaints department, and then her case will be reviewed. Luise does just that, because Luise is quick-witted and doesn't take any nonsense; after all, she's paying for the service. She then describes her ingrown toenail in great detail, which prompts the staff to consult with the doctors and nurses involved. Naturally, Luise then receives a lengthy apology email promising that such behavior won't happen again because it doesn't meet the hospital's quality standards. Are there any consequences? Of course not. If she shows up at the emergency room again with her little problem, she'll wait just as long and be dealt with just as quickly, because she simply doesn't belong there with her minor ailment. The only thing the clerks, doctors, and nurses have lost is their working time, which they then have to fill with more nonsense.
Luise may not be the sharpest tool in the shed, but she's a product of a systemic problem that extends far beyond just foot pain. The declining number of general practitioners and specialists in private practice, coupled with the difficulties in getting appointments, leads to hospitals being visited more often than necessary. After all, there's always a doctor available there. The problem is well-known, but it's not being addressed politically. Recruiting foreign specialists was supposed to solve it--but the reality is that Germany struggles with recognizing foreign qualifications and degrees. We've also devised a ridiculous procedure for this: A doctor who comes to us from outside the European Union is allowed to practice for a limited period. After that, they can't anymore. Then he has to painstakingly fight for his medical license and provide all sorts of documentation proving his knowledge and skills. In other words, for a period of one to two years, he poses no danger to humanity and is allowed to practice medicine. But once that period expires, he's suddenly dangerous and has to prove he isn't. What's the point of that?
These are just a few examples of the debilitating problems within the healthcare system. I'm optimistic that all sectors of our labor market contain similarly pointless jobs, leading primarily to employee burnout. We have no idea of the economic damage caused by our own regulations, inefficient processes, entitlement, and lack of direction. The average sick leave of approximately 15 working days per year, as denounced by Friedrich Merz, is the least of our society's and labor market's problems. Considering all the nonsense described--and, as I said, this is just a fraction of it--we can all be thankful that employees are typically absent for only three weeks.
28.01.26
©Daniel Nuber
In his book "Rust, Weed, and Rakija," Daniel Nuber describes his journey through the Balkans. He is also a certified specialist in the health and social services sector and works as an author, videographer, and photographer.
CLICK HERE FOR THE NEW BOOK
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