Heilpraktiker und öffentliches Gesundheitswesen

Abstract

In Germany, the naturopathic practitioner, the "Heilpraktiker", is allowed to practice medicine, like medically trained physicians. The German heilpraktiker, a specific German phenomenon embedded in the country's history, practices medicine without being obliged to undertake any medical teaching or training. Anybody 25 years old or older, with a secondary school certificate, and free of disease can participate in a test, conducted by the local health authorities to "exclude danger to the health of the nation." In the case of failure, this test can be repeated ad libitum. Having passed this test, the heilpraktiker is allowed to practice the whole realm of medicine, except for gynecology, dentistry, prescription of medication, and healing infectious diseases. There is no more state control during the heilpraktiker's working life, except in those practices applying invasive methods, such as infusions, injections, oxygen therapy, and acupuncture. These practices are inspected by the public health department based on the Infection Protection Act. Although several cases of fatal errors in treatment are known, the greatest risk in the heilpraktiker's practice is the omission of proper diagnostics and therapies, which is risk by omission. In this paper, the history of the heilpraktiker in Germany as well as the task of the Public Health Departments in testing the candidates are shown. The data of 345 tests from 2004-2007 in the Rhein-Main area are presented, with 53% of the participants failing. Concerning the hygiene control visits, a concept for hygiene was lacking in 79% of 109 practices, while in 49% a concept for cleaning and disinfection was also missing. In 60% of the practices, a dispenser for hand disinfection was lacking. Recommended improvements were quickly performed in most practices. In conclusion, the current legal regulation, i.e., testing the candidates only once before practicing for a lifetime, does not sufficiently protect the population against danger caused by false diagnostics and (invasive) therapy of the heilpraktiker. Considering the population's increasing interest and use of complementary and alternative medicine (CAM) with a heilpraktiker being frequently consulted, there are growing concerns in health services, regarding (1) how to regulate CAM professions and natural health procedures, (2) how to incorporate safe CAM into school medicine, and (3) how best to protect the public from a wide range of possible CAM-conventional medicine interactions.

Complementary and alternative medicine (CAM) as part of primary health care in Germany–comparison of patients consulting general practitioners and CAM practitioners: a cross-sectional study

“…The legal practice of HPs was established in the late 1930s [4] but this group are not regulated health professionals in the traditional sense. To “qualify”, HPs have to pass an exam on basic medical knowledge and skills at a local public health office to obtain initial state recognition and in order to “exclude danger to the health of the nation” [4]. No formal medical training is required and there is no compulsory curriculum for schooling, advanced training or achieving practical skills.…”

Herbal Medicine in Primary Healthcare in Germany: The Patient's Perspective

“…Furthermore, HM is often provided by nonmedical CAM practitioners called “Heilpraktiker.” They have to pass an exam on basic medical knowledge to obtain a state license but have no formal training on CAM and HM specifically [6]. While the number of GPs in Germany is decreasing (41.642 GPs in 2011), the number of “Heilpraktiker” has increased over the last years to nearly 32.000 today [4].…”

Endorsement of alternative medicine and vaccine hesitancy among physicians: A cross-sectional study in four European countries

“…The higher rates observed in Germany may be explained by a greater integration of CAM into the German health system, as this country has recognized natural health practitioners ( heilpraktiker ) since the late 1930s, 66 and it is also common for German medical doctors to provide CAM – around 60% in some surveys. 27 , 67 Natural health practitioners only require an examination on basic medical knowledge at a local public health office to become accredited, so university medical education and advanced training are not necessary for CAM practitioners in Germany.…”