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Lacking health workers, Germany taps robots for elder care

The white-coloured humanoid "Garmi" does not look much different from a typical robot -- it stands on a platform with wheels and is equipped with a black screen on which two blue circles acting as eyes are attached.

Published: 19 March 2023 10:29 CET
Lacking health workers, Germany taps robots for elder care
The artificial hand of the Garmi robot is seen in front of the robot in the laboratory of the Research Center Geriatronics of the Technical University Munich. Photo: Christof STACHE/AFP.

But retired German doctor Guenter Steinebach, 78, said: “For me, this robot is a dream.”

Not only is Garmi able to perform diagnostics on patients, it can also provide care and treatment for them. Or at least, that is the plan.

Garmi is a product of a new sector called geriatronics, a discipline that taps advanced technologies like robotics, IT and 3D technology for geriatrics, gerontology and nursing.

About a dozen scientists built Garmi with the help of medical practitioners like Steinebach at the Munich Institute of Robotics and Machine Intelligence.

Part of the Technical University of Munich, the institute based its unit specialising in geriatronics in Garmisch-Partenkirchen, a ski resort that is home to one of the highest proportion of elderly people in Germany.

Europe’s most populous country is itself one of the world’s most rapidly ageing societies.

With the number of people needing care growing quickly and an estimated 670,000 carer posts to go unfilled in Germany by 2050, the researchers are racing to conceive robots that can take over some of the tasks carried out today by nurses, carers and doctors.

“We have ATMs where we can get cash today. We can imagine that one day, based on the same model, people can come to get their medical examination in a kind of technology hub,” said Abdeldjallil Naceri, 43, the lead scientist of the lab.

Doctors could then evaluate the results of the robot’s diagnostics from a distance, something that could be particularly valuable for people living in remote communities.

Alternatively the machine could offer a more personalised service at home or in a care home — by serving meals, opening a bottle of water, calling for help in case of a fall or organising a video call with family and friends.

‘We must get there’

In the Garmisch laboratory, Steinebach sat down at a table equipped with three screens and a joystick as he got ready to test the robot’s progress.

At the other end of the room, a researcher designated as a test model took his spot in front of Garmi, which poses a stethoscope on his chest — an action directed by Steinebach from afar via the joystick.Medical data immediately appear on the doctor’s screen.

“Imagine if I had had that in my old practice,” Steinebach said, while moving the joystick.

Besides the retired doctor, other medical practitioners also visit the lab regularly to offer their ideas and feedback on the robot.

“It’s like a three-year-old child. We have to teach it everything,” Naceri said.

It’s anyone’s guess when Garmi might be ready on a commercial scale. But Naceri is convinced that “we must get there, the statistics are clear that it is urgent”.

“From 2030, we must be able to integrate this kind of technology in our society.”

Question of trust

And if it is indeed deployed one day, residents of the Sankt Vinzenz retirement home in Garmisch, a partner of the project, will likely see Garmi whizzing down the corridors.

Just thinking about it made Mrs Rohrer, a 74-year-old resident at the home, smile.

“There are things that a robot can do, for example, serve a drink or bring meals,” she said as Eva Pioskowik, the director of the home, did her nails.

Pioskowik, who battles with staffing shortages on a daily basis, said she did not expect the robot to take the place of health workers.

“But it could allow our staff to spend a bit more time with the residents,” she said.

For Naceri’s team, one of the major challenges is not technological, medical or financial.

Rather, it remains to be seen if most patients will accept the robot.

“They need to trust the robot,” he said. “They need to be able to use it like we use a smartphone today.”

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OPINION AND ANALYSIS

OPINION: Why it’s becoming harder to get a doctor’s appointment in Germany

Germany's health service is known as one of the best in the world but securing a timely appointment with a doctor is getting harder. A creaking system and the culture around excessive doctor visits are part of the problem, argues Brian Melican.

Published: 17 May 2024 11:54 CEST
OPINION: Why it's becoming harder to get a doctor's appointment in Germany

Germans have always been known for being health-conscious – some would even say hypochondriacs. That has its down-sides (see Covid…), but also some notable advantages. One is the ability to go to any doctor’s practice and request treatment, skipping general practitioners, referrals, and all of the attendant bother.

As a result, in any well-to-do area of a major German city, you’ll have a bewildering array of medical practitioners within walking distance, from general physicians (Allgemeinmedizin) and orthopaedic practices (Orthopädie) to ones that will have you Googling (HNO stands for Hals-Nase-Ohren – ears, nose, and throat – by the way. You’re welcome.)

The strength of this patient-choice system is that it allows people to manage their own care. So if one doctor can’t see you, you go and find another. And if you’ve moved towns or fall ill away from home, you can still access care. In theory, this spreads demand and keeps people with non-urgent complaints out of casualty wards. Yet in practice, the system is now creaking audibly. 

In recent months, I’ve tried to get appointments for several routine procedures with doctors’ offices I have been visiting for years – and the earliest I could get anything was, to my surprise, now several months off. Both dentists and dermatologists are currently, it would seem, planning their schedules for September and October. And when a rather unpleasant case of shoulder pain struck earlier this year (fittingly, just ahead of my 39th birthday…), the earliest appointment I could get at any of the three(!) local orthopaedic practices was at least a month off.

This isn’t just me getting unlucky here. In a recent representative survey, only 25 percent of respondents reported having no trouble getting a doctor’s appointment. The rest are having to wait anything between two weeks and two months – and I’m clearly now one of the 15 percent who report even longer delays. 

I’m not alone in thinking – knowing – that it didn’t used to be this way. So what has gone wrong? 

READ ALSO: Seven things to know about visiting a doctor in Germany

Structural changes in medical practice: fewer doctors working fewer hours

First off, there are changes afoot among Germany’s niedergelassene Ärzte – literally ‘settled doctors’ with surgeries, called so in order to distinguish them from hospital medics. For one, these doctors are getting old and retiring – just like the population they serve (or rather: have served). And as younger cohorts are less numerous, physicians looking to pass on their practices are having difficulty finding takers – especially in disadvantaged urban areas or out in the sticks.

A patient undergoes a consultation with his doctor.

A patient undergoes a consultation with his doctor. Photo: picture alliance/dpa/AbbVie Deutschland GmbH & Co. KG | AbbVie Deutschland GmbH & Co. KG

Even where there is no shortage of potential successors, ever fewer of them actually want to set up in business for themselves. For most young medics’ taste, there’s too much paperwork, too much commercial risk, and far too much work involved in running their own surgery. Instead, they prefer to merge with others or sell on to management companies who will, in turn, employ them (often part-time, with no annoying evenings or weekends on call). 

The results of all of this are as follows. Within the space of just one year, between 2022 and 2023, the number of surgeries fell by 1,987 – a drop of over two percent. Meanwhile, in 2023, for the first time ever, more than one third of Germany’s 150,000 non-hospital doctors were employees, not self-employed. That’s twice the number in 2013. Moreover, over the same period, the number of medics opting to go part-time has gone up by 235 percent to 60,000. This means that, if your local surgeries haven’t closed, the likelihood is that the doctors there are now working fewer hours – and so there are fewer appointments left to go round.

READ ALSO: Do doctors in Germany have too little time for their patients?

This would be bad news for any society, but it hits particularly hard in Germany. As a rapidly-ageing society with a relatively unhealthy population (high rates of smoking and obesity), our demand for medical services – often for complex chronic illnesses – is rising just as provision is declining.

Cultural differences in consulting doctors

Another problem is that Germans are accustomed to a historically high number of available doctors – and as serial worriers (and passionate sick-note seekers) make excessive use of them. Your average German racks up almost 10 consultations a year – not including visits to the dentists! The OECD average is closer to six. And the stoic Swedes, strong silent types that they are, go the doctor’s just 2.3 times a year.

Even if I wanted (or needed) to, I simply couldn’t to get to the quack’s almost once a month: I don’t have the time and they don’t have the appointments. But in conversation, I notice that others clearly do manage to find both. Increasingly, I’m wondering how many of them, unlike me, have private health insurance. 

This brings us to the third major issue facing non-hospital care in Germany. When the figures in the representative survey I quoted above are broken down, it transpires that almost 60 percent of people who are insured in the state system (gesetzlich versichert) are now waiting longer than two weeks for an appointment; among those who are privately insured (privat versichert), that figure is only 37 percent.

Doctors ‘keen on private patients’ 

Doctors are keen on private patients because their insurers pay more for the same procedures and will also cover all sorts of supplementary stuff – from the clinically-proven through to the just plain wacky. As such, practices reserve as many appointments as possible for private patients and try to keep the rest of us at bay.

Given that around four in five people in Germany are in the state system, however, this leaves the majority of patients competing for the minority of slots. If you want to see how the other fifth live, try “accidentally” clicking privat on surgeries’ online booking tools: you will now see a range of appointments available within days while the rest of us are being fobbed off for weeks or even months.

Not only is this, as my grandmother used to say, enough to make you want to join the Communist Party – it’s wildly inefficient. By restricting the hoi-polloi to slots often months off, doctors are creating their own appointment-management problems: sometimes, the complaint in question will have disappeared by the time the consultation rolls around; more often, it will have actually been dealt with – not infrequently by the same physician – if the patient presents as an acute case earlier.

As such, slots weeks away are booked, only to be cancelled later by conscientious patients (and left blocked by others), while those same patients crowd into waiting rooms begging to be seen urgently at an open surgery. (That’s how I got my shoulder looked at.)

A German health insurance card.

A German health insurance card. Photo: picture alliance/dpa | Jens Kalaene

The cynic in me says that, in the long run, this might not be such a bad thing. If the increasing scarcity of doctor’s appointments gets Germans thinking about whether they really, really need to be seen for yet another case of the common cold (“No, Christian, it isn’t pneumonia this time, either!”) or various nebulous self-diagnosed ills (Kreislaufbeschwerden (circulatory problems) is the day-off-work-one I love to hate), maybe it’s not a bad thing.

Swedes don’t die unnecessarily because they avoid the doctor’s: in fact, they live a good year longer than us on average. The German in me, though, says: “My shoulder hurts. Maybe I’ve got early-onset arthritis. I should probably go and get it checked out…” And even though I don’t go too often, I’ve got used to being able to see a specialist when I need one. It’s a shame that this is becoming markedly more difficult.

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