On Trust, Safeguarding – and a Medicine That Has Entangled Itself

January 2026: Too many patients, too many doctor visits, too little management – ​​that's the current diagnosis. But perhaps it's not demand that has spiraled out of control, but rather trust. Those who have relied on safeguarding, control, and intervention for years shouldn't be surprised when people expect precisely that. Do patients really need to be managed – or does the healthcare system primarily need the courage to question itself?

The demand for "patient management" resurfaces time and again. It's voiced almost ritually, usually by medical associations, often with the same diagnosis: too many doctor visits, too many consultations for minor complaints, too little precision. The healthcare system is overloaded, demand has spiraled out of control. Patients, the subtext goes, need to be better managed – for their own protection and for the protection of the system.

But from the perspective of a patient and citizens' association, it's worth taking a closer look – because this narrative is surprisingly one-sided. It presents the demand as a natural problem and ignores how it actually arose.

For decades, medical care has developed in a direction that promises safety primarily through intervention. Symptoms are investigated early, progress is closely monitored, and uncertainties are resolved diagnostically. Low access thresholds are considered a mark of quality, and frequent contact is seen as an indication of good care. Patients have learned: if something is unclear, it's better to come back; for minor complaints, it's better to get it checked out; and for deviations from the norm, it's better to take action.

This expectation didn't just appear out of thin air. It's the result of a system that is itself under increasing pressure: medical practice today operates within a dense web of liability issues, fears of recourse, documentation requirements, and guidelines that are interpreted not only medically but also legally. What was intended to protect patients has increasingly pushed medicine into a mode of self-protection.

In this mode, the primary question is no longer what is appropriate in a specific case, but rather what appears legally unassailable. Waiting becomes risky, and not intervening requires explanation. Better one examination too many than one too few, better one more check-up than an open ending. Defensive medicine is no longer the exception, but rather the norm in many places.

This has noticeable consequences for patients. Additional diagnostics don't always bring clarity, but often create new uncertainty. Follow-up appointments reinforce the feeling of being ill or of being at risk of becoming ill at any time. A system that protects itself out of fear of errors constantly generates new reasons for treatment and then wonders about its own overload.

Consequently, the focus shifts to those who use the system: the patients. They come too often, it is said. Too early. Too disorganized. Therefore, they must be managed.

What gets lost in this logic is a resource that is central to any functioning medical system: trust. Trust that not every uncertainty needs to be resolved immediately through technology. Trust that waiting can be a legitimate medical option. Trust that patients can cope with risks and uncertainty—if they are taken seriously and involved.

But trust is difficult to maintain in a system dominated by legalistic principles. Where documentation becomes more important than conversation, the relationship loses its significance. Where guidelines primarily serve as legal safeguards, joint deliberation becomes risky. Patients sense this. And they react as people react in uncertain systems: with questions, renewed expectations, and a desire for additional reassurance.

This creates a self-reinforcing cycle. Less trust leads to more control. More control generates more demand. And ultimately, there is a call for management—as a technocratic substitute for what has been lost.

The real question, therefore, is not whether patients need to be better managed. The real question is whether a healthcare system that has institutionalized mistrust can still allow for restraint at all. Because anyone who has conditioned people over the years to seek medical reassurance for every uncertainty shouldn't be surprised when they continue to demand exactly that.

Sustainable relief for the system won't come from new obstacles, but from a cultural shift: through legal frameworks that once again legitimize doctors' wait-and-see approach; through reimbursement systems that don't penalize time, communication, and restraint; through