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EXPLAINED: The changes around doctor’s notes in Germany you should know

Now the temperature has dropped we're more likely to pick up infections. If you need to take time off work, you should be aware of Germany's doctor's note procedure and some important recent changes.

A woman lies on the sofa with medicine for a cold
A woman lies on the sofa with medicine for a cold. Germany is in the process of digitising sick notes. Photo: picture alliance/dpa/dpa-tmn | Christin Klose

If you feel ill or pick up an infection like the common cold or flu, you’ll think about calling your doctor. It could be to find out if you need any treatment, or you might need to get a sick note which can be given to your employer for time off work.

Some employers ask their employees to submit an incapacity to work certificate (the Arbeitsunfähigkeitsbescheinigung or AU-Bescheinigung) on the first day of illness.

Most companies, however, are more accommodating and do not require the certificate (also known as a gelbe Schein or Krankschreibung) until on or after the third day. Your employment contract clarifies what applies in the case of each employer. The rule should be listed under “sickness” or “continued payment of remuneration in the event of sickness”.


What’s changed about sick notes from the doctor?

Germany is in the process of digitising the sick note procedure as a way of minimising bureaucracy (something we can all get on board with).

Previously, three copies of the sickness certificate were given to the patient from a doctor. But since October 1st, the doctor issues only two documents – one for the patient to keep as a record and one for the employer.

The health insurance company should now be informed automatically by the doctor. 

A doctor signs an incapacity to work slip in Germany.
A doctor signs an incapacity to work slip in Germany. Photo: picture alliance/dpa/dpa-Zentralbild | Paul Zinken

And from July 2022 at the latest, the health insurance organisation will be responsible for informing the employer about the sick note. Patients can therefore concentrate entirely on getting well – and don’t have to worry about submitting certificates to their boss. 

Germany had originally planned to fully digitise sick notes at the start of this year, but this was pushed back to allow medical practices and insurers time to prepare. 

READ ALSO: How Germany plans to ditch paper sick notes for digital ones

Some health insurance firms, such as Techniker Krankenkasse (TK), have been running pilot projects for sick notifications to be transmitted digitally to employers so you may have already come across this procedure. 

Should I be aware of anything else?

This rule is fairly new so patients should double check with their doctor to find out if they plan to forward your sick notification to the health insurer. 

As we are in the transitional phase, it might not yet be practised by all doctors. If the doctor has not got a system in place yet for sending the sick note to the health insurance firm, then you can ask for a copy and send it yourself. Some insurance firms allow people to upload it via an app. 

Those who have statutory health insurance must forward the sick note to their insurer quickly so as not to lose any entitlement to sick pay.

When reporting that you’re sick, it’s important to inform the boss by e-mail or telephone (depending on the procedure in your work place) as soon as possible. This is called a Krankmeldung or notification of sickness.

The sick note should  be forwarded to the HR department or your manager. In many cases, a mobile phone photo of the sick note is sufficient; larger companies have a separate postal address where the sick leave certificates must be sent.

If you feel ill or unwell, you should generally avoid the office or your workplace to protect other colleagues from infection. If you are able to work, check with your boss whether you can work from home during that time. 

If you suffer from fever, cough or cold, it’s probably best to consult a doctor. If they suspect that it is Covid-19 you will be offered a PCR test free of charge and advised to self-isolate.

Is the AU certificate also available via video consultation?

Since July 2020, doctors have also been able to issue sick notes via video consultation (Videosprechstunde)

But there are some rules to keep in mind. For instance, the sick note is valid for a maximum of seven days when first issued through the video consultation. If an extension is needed, the patient has to go to the doctor’s office. If the patient first received the sick note in person from the practice, he or she can extend the sick note via a video consultation once.

The National Association of Statutory Health Insurance Physicians (KBV) emphasises that an important prerequisite for issuing the sick note via video consultation is that the patient is “personally known to the practice through previous treatment”. So you can’t access this service with a new doctor. 

Meanwhile, doctors can also give sick notes for respiratory illnesses such as Covid-19, flu or the common cold over the phone due to the pandemic. This rule is in place until at least the end of 2021. 

READ ALSO: Everything you need to know about making a doctor’s appointment in Germany

In Germany, the number of patients who are requesting a video appointment with a doctor is growing.

According to a representative Allensbach survey commissioned by the medical technology group Fresenius, 46 percent of those surveyed were open to video consultations at the end of last year, compared to only 22 percent four years earlier. In the same period, the proportion of those who ruled out video consultations with their doctor fell from 70 to 41 percent.

Acceptance of online consultations has also increased among doctors in Germany. In the second quarter of 2020, patients consulted a doctor or psychotherapist by video almost 1.2 million times – more than ever before, an analysis by the the National Association of Statutory Health Insurance Physicians (KBV) found earlier this year. 

The numbers have skyrocketed during the pandemic. While there were just under 3,000 video consultations nationwide in 2019, there were almost 1.4 million in the first half of 2020. 

Here’s a roundup of some useful vocabulary:

Incapacity to work certificate – (die) Arbeitsunfähigkeitsbescheinigung or AU-Bescheinigung

Sick note – (die) Krankschreibung

Notification of sickness – (die) Krankmeldung 

Video consultation – (die) Videosprechstunde

Cold – (die) Erkältung

Sick day – (der) Krankheitstag

Sick leave –(der) Krankenstand (KS)

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Who can get the monkeypox vaccine in Germany – and how?

The monkeypox virus continues to spread in Germany and the vaccines panel is recommending that three groups of people get a jab. Here's who can get one - and how.

Who can get the monkeypox vaccine in Germany - and how?

What’s the current monkeypox situation in Germany? 

The monkeypox virus is still spreading in Germany, with 2,982 confirmed cases of the disease recorded by the Robert Koch Institute (RKI) as of Tuesday.

The virus, which causes small lesions on the skin alongside flu-like symptoms, is primarily transmitted through close physical and sexual contact. The vast majority of cases have so far been found in gay men, though five women have also had the virus in Germany to date. 

On Tuesday, the RKI reported that a four-year old girl in Baden-Württemberg had contracted monkeypox from two adults in her household but was asymptomatic. Before that, two teenage boys aged 15 and 17 were also found to have picked up an infection. 

READ ALSO: Monkeypox in Germany: Two teens ‘among new infections’

With the number of cases rising globally, the World Health Organisation (WHO) has declared the situation an “emergency of international scope” – the highest alert level possible.

This is a sign for members of the WHO like Germany to implement containment and preparation measures, such as rolling out vaccination campaigns. For its part, the Robert Koch Institute (RKI) is tracking the cases and has put out an information sheet about the best practices for avoiding the measures and what to do in the case of an infection.

What should people do if they contract the virus?

If people think they have a monkeypox infection, the first thing they should do is seek the advice of a healthcare practitioner such as a GP or sexual health advice clinic. However, the RKI advises people to phone the clinic beforehand to let them know they believe they may have the virus.

In confirmed cases of monkeypox, people should self-isolate at home until the lesions on their skin scab over and peel over, but for a minimum of 21 days. They should avoid physical contact and sharing items like hand towels or bed sheets with others and should wear condoms during sex for at least eight weeks.

Healthy people with no pre-existing conditions are generally fine to remain at home with someone who has contracted monkeypox, but those with weakened immune systems, pregnant women, elderly people and children under the age of 12 should move out for the duration of the isolation. 

READ ALSO: EXPLAINED: How Germany wants to contain the monkeypox

What monkeypox vaccines are available? 

The smallpox vaccine Imvanex, which has been available in the EU since 2013, was approved for use against the monkeypox virus on July 22nd, 2022. 

People are generally protected against monkeypox for at least two years after their first dose of Imvanex, but doctors recommend a second dose after a four-week interval in order to make this protection permanent. 

The vaccine is generally seen as a preventative measure but can also be used up as a so-called post-exposure measure to lower the risk of getting ill after contracting the virus. In this case, the vaccination is most effective up to four days after exposure. 

Who are monkeypox vaccinations recommended for? 

So far, the Standing Vaccines Commission (STIKO) has recommended that two primary groups of people get a monkeypox jab: men who have multiple male sexual partners and people who work in infectious disease laboratories. 

As mentioned, the vaccine can also be used to ward off illness or prevent a severe course shortly after someone has been exposed to the virus. 

READ ALSO: German vaccine panel recommends monkeypox jab for risk groups

Nurse laboratory monkeypox PCR

A nurse sorts monkeypox test samples in a lab. Photo: picture alliance/dpa/EUROPA PRESS | Carlos Luján

Is there enough vaccine to go around?

Not currently.

In May, the German Health Ministry preemptively ordered 240,000 doses of the vaccine – but so far just 40,000 of these have been delivered. 

This is far too little to cater for the estimated 130,000 people who fall into one of the target groups for a jab.

The remaining doses are due to be delivered in August and September, though some pressure groups are already calling for more to be ordered. 

On Friday, the German Aids Federation (DAH) called on the government to secure at least one million doses of the monkeypox vaccine in order to help stamp out the virus in Germany. 

“The goal must be to reduce the number of infections as quickly as possible and to get the epidemic permanently under control,” explained Ulf Kristal of the DAH board.

This can only be done if as many people in risk groups as possible are vaccinated, he added. 

How can people book a jab?  

At the moment, this varies quite a bit from state to state, with some issuing the jabs via the local health authorities and others supplying the doses to specialist HIV clinics and hospitals.

In Saxony-Anhalt, Bremen and Hesse, vaccinations are primarily organised through the local health authorities, so this should be your first point of contact to enquire about a jab if you live in these states. In Frankfurt am Main, however, a handful of specialised HIV clinics are also carrying out vaccinations, according the FAZ newspaper. 

In Saarland, too, appointments should be booked through the health authorities, though they are carried out at Saarbrücken University Clinic. In Hamburg, jabs are being administered solely at infectious disease clinics.

UKE university clinic Hamburg

The main entrance to the University Clinic in Hamburg, where monkeypox patients have been treated for the disease. Photo: picture alliance/dpa | Axel Heimken

Berlin offers the most diverse range of vaccinations and, with 8,000, has the largest number of vaccine doses available. Vaccinations are given in HIV specialist practices, counselling centres for sexual health as well as in several hospitals. A list of vaccination centres has been compiled by the German Association of Outpatient Doctors for HIV Treatment. Neighbouring Brandenburg organises vaccinations through the local health authorities as well as through GP’s practices.

In three federal states, only hospitals are responsible for monkeypox vaccinations. In Saxony, hospitals in Chemnitz, Leipzig and Dresden have been vaccinating since the end of June. In northern Schleswig-Holstein, outpatient clinics in Kiel and Lübeck are responsible. Neighbouring Mecklenburg-Western Pomerania is administering its doses exclusively through the University Medical Centre Rostock.

Several federal states have opted to roll out monkeypox vaccinations through both HIV clinics and hospitals. These include Bavaria, which has more than 3,500 vaccination doses available, as well as Rhineland-Palatinate, Lower Saxony and North Rhine-Westphalia, for which a list of all vaccination centres was recently published.

What else should people know? 

The monkeypox vaccine is perfectly safe, but people can experience a few side effects for a day or two afterwards, including soreness on the vaccination arm, fever and headaches. 

People with HIV should talk to a specialist before getting the vaccine, because the effectiveness may vary depending on your Helper T cell count. 

For more information on the clinics offering jabs, the German Aids Federation has published a helpful Q&A along with a list of clinics in each of the federal states, which can be found here (in German).