Where top-level medicine meets well-being

If you feel sick, you go to the doctor. But often such an appointment in a practice or clinic is associated with excitement, often even fear. To take these away so that patients feel as comfortable and well taken care of as possible, it is no longer enough just to lay out a few magazines in the waiting room or to put up a plant.

The expectations of patients have changed significantly, already due to social change: The classic paternalistic communication model "'Gods in white' pronounce a disease verdict" has given way to communication on an equal footing and a more partnership-like level - especially as health literacy has increased enormously thanks to Dr. Google.

This has led to patient empowerment, which doctors must also respond to. And: Reputation today is not only created because medical excellence is right, but also when patients and the internet confirm it. The consequence: practices and clinics are rethinking and redesigning the patient journey - from communication to healthcare design.

Patient communication: Building trust

Studies show how important it is that communication in health matters takes place on a human-oriented and partnership-based level and ideally culminates in a joint decision towards treatment or prevention. "Shared Decision-Making" is the magic word here, which increases the chances of treatment success.

It is crucial that both sides have a good feeling. It helps patients to build a basis of trust - ideally from practice management to treatment by a doctor or staff. "If you feel poorly taken care of, you should not be treated," says Dr. Lukas Kohler from the Munich Aesthetic Institute LVATE. And the converse is also true: "If you feel that the patient does not trust you, you should make a stronger effort to gain the lacking trust - or refuse treatment if necessary," says Kohler.

Another dimension: Communication must also work smoothly within the team - because there are also people sitting there who have needs, worries, good and bad days. And this affects the mindset that patients expect. That's why Gall increasingly relies on internal feel-good measures, such as employee coaching. He himself also uses these opportunities:

"To make sure the patient is doing well, you have to take care of your own mental hygiene and mental health." However, professional-political framework conditions also create difficulties in the doctor-patient relationship: "Many doctors, according to the Uniform Evaluation Standard (EBM), have only 10 minutes of contact time, during which it is neither possible to take an anamnesis nor to get to know the patient," says Dr. Gall.

Getting to know each other better is also one of the central concerns of heart surgeon Dr. Ferdinand Vogt from the Artemed Klinikum München Süd. That's why he involves the relatives right from the start. On the one hand, he learns more about the patients and their living conditions, for example, whether they are able to take care of themselves.

On the other hand, he also learns more about the expectations associated with the procedure: What is possible and what is not? "Our challenge is always to be able to offer everyone an individual, optimal treatment concept," says Vogt. The goal: To reintegrate patients into their daily lives as quickly as possible.

Another aspect: "The heart is not only an important organ, but also emotionally charged. For me, it is a matter of course to pick up the phone and inform those waiting at home about the progress," says Vogt. For the heart specialist, "also treating" relatives is part of the care.

For the Hamburg ophthalmologist Dr. Johannes Gonnermann, relatives also have a psychological component, especially for older patients or children. "We recommend bringing familiar companions, parents or grandparents to the appointment to ensure additional emotional security and a comfort zone."

He places importance on being a practice for all generations, which is why he relies on individual communication and comfort concepts: Older people receive information about the length, duration, and type of preliminary examination in advance to prepare.

"In communication, calm and clear formulation at an adjusted speaking pace in a calm atmosphere is extremely important. In education, we use illustrative eye models to clearly and sensitively explain the nature of the procedure." For small patients, there is a child-friendly extra waiting room. It often helps to reduce anxiety if the child can focus on something else.

Recover better and faster after an operation

A stay in a clinic or practice is usually an exceptional situation for patients. Here, too, there are approaches to make this more pleasant and thus more effective. The pain specialist Dr. Claudius Gall for example, allows patients a wellness phase after an infiltration - an injection in the spine area - to balance the pain and maximum stress. They are allowed to relax in a spa-like relaxation room with music and mud until their normal stress level is reached again. During this time, all relevant health parameters are monitored.

Another novel approach: Since no one wants to stay in a clinic longer than necessary, the so-called corridor before and after the intervention is now being used more effectively. Programs like ERAS (Enhanced Recovery After Surgery), which can reduce complication rates by up to 80 percent, are available for this purpose. This is a concept embraced by Prof. Dr. Franz Bader, Medical Director of the Clinic for General, Visceral, and Minimally Invasive Surgery at the ISAR Klinikum Munich.

It is one of the few clinics that are already certified for this. Under the motto "Better in, better out," the rehabilitation begins even before the surgery, so patients go into the operation as fit as possible. The program is interdisciplinary. It includes balancing any deficiencies with electrolytes, amino acids, and vitamins before the procedure or smoking cessation. Even shortly before the surgery, stress is minimized: patients are allowed to eat up to six hours before and drink up to two hours before.

Subsequently, patients are quickly mobilized by specially trained ERAS nurses - even after major operations, a joint walk in the ward on the same day is the norm. The goal is to discharge patients back to their normal lives as soon as possible. This is also made possible by gentler minimally invasive methods. While patients used to stay in the hospital for up to three weeks after colon cancer surgery, today, thanks to robotics and new concepts, it's only about four days.

The psychological effect of concepts like ERAS should not be underestimated. "When you hear that you can't eat or drink anything initially, the upcoming operation seems more severe - this alone increases the stress level," says plastic surgeon Dr. Caroline Kim. That's why her patients are allowed to drink not only water but also sweetened tea or even espresso in the morning before the operation.

Previously a no-go, it is now known that keeping blood sugar levels from dropping too low can lead to less postoperative nausea. Many old dogmas have become obsolete. "There is no need to burden people if there is no scientific basis for it," says Dr. Kim.

Practices and clinics: Get rid of the fear

Returning lost self-confidence is the aim of Artedent dental practice in Munich. Owner Dr. Paul Schuh primarily targets patients with anxiety, as a visit to the dentist is particularly stressful for most people. To alleviate this fear, he has installed a large swing in the entrance area.

"Everyone associates swinging with a comforting feeling; it reminds them of childhood and being rocked in someone's arms. We notice in our patients that this reduces their tension and helps them come into the treatment room calmer and more relaxed."

Digitalization also allows many treatment steps to be planned and prepared virtually, which reduces the so-called chair time, which also causes stress. Transparency is another tool that alleviates fear. "Our laboratory is like an open kitchen. Nothing happens behind closed doors; everyone can watch how crowns are made, which builds trust," says Dr. Paul Schuh.

His dentist colleague Dr. Firas Zoubi from Ibbenbueren, North Rhine-Westphalia, also relies on a glass laboratory, where patients can experience live how a tooth is built up layer by layer. But that's not all: "Many people, for example, are afraid that after a so-called smile makeover - an improvement in dental aesthetics - they will no longer be themselves."

That's why mock-ups are created so that patients can not only see what they look like with their new teeth (via before-and-after photos taken in their own photo studio), but also feel them in their mouth. “Mock-ups can be adjusted and corrected as desired during the course of further treatment," explains Zoubi, "so that the result can already be seen by the patients in advance and only holds positive surprises."

Often, such dental treatment reactivates slackened facial muscles, "which ultimately leads to the release of happiness hormones," says Dr. Firas Zoubi.

Color, light, interior: the health-promoting effect of healthcare design

“The rooms should radiate warmth and make patients forget that they are at the doctor’s office," says Dr. Lukas Kohler, a specialist in plastic and aesthetic surgery. His Munich-based LVATE Institute, whose interior resembles the lounge of a boutique hotel and features design classics such as Mario Bellini's Camaleonda couch, is bathed in warm light.

It smells like a spa, with pleasant music playing in the background. Dr. Kohler himself speaks of an anti-practice concept. The typical medical colors white and silver are nowhere to be found here, "people associate them with unpleasant topics like illness and pain," he explains. "That's why everyone on the team is dressed in restrained black."

Dentist Dr. Paul Schuh also forgoes white, glaring light and thus the typical clinical atmosphere at Artedent. He opted for a friendly cream and soft gray, as well as a rich green as an accent color, "because it reminds us of nature and has a calming effect. The vertical natural garden in the entrance area is supposed to reduce the perception of pain and thus help reduce the necessary dose of painkillers."

The studio Zoubi relies on an urban loft character. Open, bright and transparent was the architectural directive of owner Dr. Firas Zoubi, and so glass, wood and concrete dominate both the light-flooded ground floor with reception desk and lounge-like waiting area and the treatment rooms on the first floor.

The increasing importance of the ambiance in practices and clinics is thanks to the healing architecture movement and the realization that good design has a proven healing and relaxing effect and enhances well-being.

That's why more and more doctors are relying on a more stylish environment. So is the Munich plastic surgeon Dr. Caroline Kim, who is moving to a new practice with an attached operating area in Munich's Lodenfrey Park in April - including bird chirping, a view of the Schwabinger Bach and the English Garden.

"There are several scientific studies that prove that patients need significantly weaker painkillers, have fewer complications, feel less stressed and recover faster after surgery when looking at nature instead of a wall," says Dr. Kim.

An aspect that is important not only for the psyche of the patients, but also for the staff. That's why the operating room, “where we often spend many hours of the day,” also has windows to the greenery. The second advantage of having your own operating room: “You enter familiar rooms, meet a team that knows you by name, without any hospital feel.”

Hospital feel can also be avoided in an existing clinic, such as in the ISAR Clinic in Munich: rooms and service have a hotel character - they have a minibar, in the bathrooms you can find a bathrobe, slippers and amenity kits, food is ordered à la carte or via tablet and served with a silver cloche and cloth napkins. And there's something else that contributes to the feel-good experience: Thanks to specially developed cleaning agents, it no longer smells like a hospital.