Sick note by telephone – why it should not be abolished

Quick memory exercise: What happened in China about five years ago? Correct! The first people became ill with a then-unknown viral infection that was transmitted via the respiratory tract. Panic gripped the entire world, and horrendous figures soon began circulating about how many people would become seriously ill or even die.

We do not want to delve deeper into the debate about whether the fears were justified or whether certain protective measures were excessive. But an idea was born back then that was definitely sensible: highly infectious people shouldn’t storm family doctors’ offices because they need sick notes.

Patients who are particularly at risk due to chronic illnesses such as cancer or their advanced age also sit in the waiting rooms. That’s why an exception regulation was introduced that allowed sick leave to be taken by telephone if Corona was suspected.

This was long overdue. Because people who belong to the risk groups are also at risk from other infections in practices, especially the flu.

Based on such considerations, the highest decision-making body in the German healthcare system, the Federal Joint Committee, decided to turn the exception into the rule – under certain conditions: the patients must already be known to the respective doctor’s practice. In addition, telephone sick leave is only intended for minor illnesses such as respiratory or gastrointestinal infections. Illnesses with severe symptoms must be clarified through a personal examination. The initial certificate of incapacity for work after telephone contact may be issued for up to five calendar days, and after video consultation up to seven calendar days.

The new regulation has the nice side effect that it also relieves the bureaucratic burden on family doctor’s practices that are overrun during the flu and cold season. A win-win situation for doctors and patients. The regulation is far-sighted. Because it is only a matter of time before the next pandemic hits the world.

Nevertheless, Finance Minister Christian Lindner (FDP) is fighting bitterly to abolish the regulation. Employer associations have also been calling for this for a long time. The debate gained momentum after Germany’s largest health insurance company, AOK, reported a new peak of 225 cases of incapacity for work per 100 employed AOK insured people in its current absenteeism report three weeks ago. And that’s before the cold and flu wave in the fall, so the number could still rise.

For comparison: On average between 2014 and 2021, there were just under 160 cases of illness per 100 insured people per year. The main drivers of this development are respiratory diseases and mental illnesses. However, medical associations and health insurance companies are in rare agreement: the possibility of taking sick leave over the telephone is not exactly what is fueling this development. This is also shown by a current study by the Center for European Economic Research (ZEW), for which absenteeism between 2020 and 2023 was analyzed.

Rather, according to the AOK experts, the introduction of electronic sickness notifications could be a reason for the increase. In the past, patients were given three certificates, one of which they were supposed to send to the health insurance company – which they probably often didn’t do. Today, reports are automatically sent to the cash registers electronically.

The stress caused by global crises, the intensification of the working world and the constant availability of employees can also contribute to increased sickness reports.

Lindner doesn’t care about such rational arguments. Although he doesn’t want to accuse anyone of exploiting the regulation, he emphasizes, only to then follow up: Unfortunately, there is “a correlation between the annual sickness rate in Germany and the introduction of the measure, which was intended as a good reduction in bureaucracy.” Sick employees come under general suspicion that they are actually just lazing around. The minister would have to be taught that “correlation” is not the same as “causation” – that’s general statistical knowledge, Lindner obviously doesn’t know.

It is astonishing that the FDP, the preventer party, has once again managed to push forward an irrational, scientifically unrelated debate – and in the process also risk alienating high-earning doctors. They are all in favor of retaining telephone sick leave. And how would the FDP want to act if the next pandemic actually came? Get the regulation out of the mothballs and spend a few years discussing whether it should be reintroduced?

No, I don’t think Christian Lindner is stupid or forgetful of history. He is simply an opportunist who now wants to please employers – and soon the medical profession again with another legislative initiative. It’s just a shame that we have no time at all for such sham debates.