In Germany, doctors are often forced to work more than 24 hours straight. The average work week is between 70 and 80 hours. And every year some 25,000 patients die because of medical negligence.

The connection is obvious, say health professionals and representatives for the federal association of doctors, the Marburger Bund: German doctors are overworked and overtired. After an 18 to 20-hour shift, they are physically unable to perform all the tasks required of them.

But the German government has continually pushed aside the issue of regulating doctor’s work hours. The only thing that appears to count in terms of the government’s involvement in the health care is the growing cost to the state, says the Marburger Bund.

It’s fairly easy mathematics; the more one doctor works, the lower the personnel costs are for a hospital. Instead of employing two doctors, one can do the job with overtime. The hospital saves money and it’s less of a strain on the state’s health insurance funds.

Doctors say the issue is an important one, and not only for the professional lobbyists. Although doctors are the most immediately effected by long work hours, it is the patient who ultimately suffers with insufficient and inadequate health care.

The most frequent consequence of the 24-hour plus shifts is that the patient doesn’t get enough attention, says Ali K., a young doctor in training in Cologne. "I see it all the time", he says. The overworked doctor is "tired, restless, and inattentive. When consulting the patient, he doesn’t always listen carefully enough to what the patient is saying. Therefore he can’t diagnose correctly."

Anyone who’s worked a long shift knows that at the end of the day, mistakes happen; it’s human nature. But when a doctor is tired and makes mistakes, they can be serious, even life-threatening.

Late-night scenario

It was after midnight when a 59 year-old Berlin man arrived in the emergency room after having suffered a hit on the head with a hammer. The doctor on call took one look at the patient, diagnosed his condition as a skull fracture, and quickly sutured him up. The patient was sent home to rest.

But the patient couldn’t rest, he couldn’t even lie down. He had severe headaches and constant nervous twitches.

Three weeks later a radiologist uncovered the true source of the patient’s suffering: a bone splitter had been dislodged from his skull and was only millimeters away from penetrating his brain.

The emergency room doctor had been working an extremely long shift. She was tired and gave the patient only a perfunctory examination. Her carelessness nearly cost the patient his life.

Fortunately, such horror stories are not the norm in German hospitals. But the fact that it happened, and will continue to happen as long as doctor’s are forced to work far more than the legal number of hours, is alarming enough.

Read more about the pressures doctors face each week and the consequences for patients in Part 2: Putting Patients at Risk