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Article 2 para. 5 of the (model) Professional Code of Conduct for medical practitioners working in Germany states unequivocally:
“Doctors are obliged to comply with the regulations governing their professional practice.”
While this obligation may appear self-evident, its impact on the professional lives of doctors in hospitals, clinics and general practice is considerable. The first edition of the first Skills-based Subject Catalogue – Medicine (published in December 2020) lists all legal provisions that apply to professional medicine, including relevant standards such as the Federal Medical Practitioners’ Act, professional ordinances issued by Germany’s federal states, and medical CPE regulations. In addition, laws governing statutory and private health insurance play a role – especially the rules pertaining to the doctor-patient relationship incorporated into the German Civil Code (BGB) pursuant to the Patients’ Rights Act. The Subject Catalogue also features a list of equally important regulations from the Transplantation Act, the Prevention and Control of Communicable Diseases Act, the Medicinal Products Act, the Criminal Code, the Medical Devices Act, and the Federal Data Protection Act – to name just a few of them.
Equally striking is the fact that the legal framework governing the practice of medicine is characterised by a jungle of medical self-management. To a significant degree, legislators at both federal and state level leave it up to the doctors working in Germany to supervise their own professional interactions. In addition to the regulations governing the medical profession, the implementation of laws on social welfare is especially significant. In particular, guidelines published by the Federal Joint Committee have a major influence on daily life in hospitals and general practices.
Considering this almost overwhelming volume of regulation, it is very surprising that medical CPE programmes to date have neglected to impart the legal principles underlying professional medical practice. Only now is any provision likely to be made for legal training as a component of an aspiring doctor’s education, in the form of an amendment to the Medical Licensure Act currently being debated by the Federal Parliament. This is long overdue. In addition to statutory and sub-legislative regulations, professional medical law today is heavily influenced by existing legal precedents in case law. Professional codes of conduct, standards, guidelines and directives regulate the medical profession to such an extent that even experienced doctors can lose track of them all. While this situation is universally and constantly deplored, there is no sign of any movement towards deregulation. (Aspiring) senior managers in the health sector must therefore ensure that they are familiar with, can apply, and are capable of explaining the relevant rules and regulations to their colleagues, subordinates and associates. As well as imparting medical knowledge, providing instruction in the legal principles governing the profession is a positively Herculean task. It would be hyperbolic, not to say unrealistic, to require every licensed doctor to take a law degree after completing their medical studies – but it would undoubtedly be desirable.
Our Leadership and Management for Senior Clinicians certification programme, intended for prospective and newly appointed senior physicians, hospital consultants, heads of institutes and medical directors, instructs participants in the essential principles of and connections between the laws and regulations governing the medical profession, making them aware of the legally relevant contexts. The German Society of Medical Law (DGMR), founded in September 1982, seeks to ensure that scientific concerns are properly incorporated into medical law, and to deepen the interdisciplinary exchanges between law and medicine with the aim of improving mutual understanding. If we can successfully impart this knowledge to course participants so that it proves useful in practice, then we have succeeded.
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