I just got a second surgery on my knee after a year of a nightmare experience navigating the German health system from Berlin, and I finally have the emotional energy to share my experience, my frustrations, and my logical attempts to understand the system.

On September 21st, 2024, I had a very unlucky accident while running that led to a strong impact on my knee, causing such pain that I ended up going to the hospital in Lichtenberg by ambulance.

Early experiences already felt unexpected. From the ambulance crew refusing to give me any water to the hospital calming my unbearable pain with random ibuprofen here and there. Something didn't seem right. My right foot dropped. I thought about lifting it up, and nothing happened. As if my brain's messages couldn't reach the muscles in charge of that movement. I told them, but they didn't think it was their responsibility. The X-ray showed the meniscus was fine, the tibial plateau slightly impacted, and swelling in the area. After 8 hours there, they sent me home with a knee brace, which I later realized wasn't a good idea, and the recommendation to visit a trauma specialist on Monday.

Monday came, and I went there early to make sure I'd get a slot. The room was packed with people. He spent 5 minutes at most with each patient. My turn came, I went in, told him everything that happened, and he sent me home, suggesting I continue with my leg elevated, injecting heparin, and regarding my concern about the foot drop, he suggested I get an appointment with a surgeon in the same building. They gave me the appointment 4 months later, and part of me thought it was okay because I didn't think there was a connection between the swelling and the nerves. In other words, I thought I'd recover the movement as soon as the swelling was gone.

Weeks went by, and with them, appointments with the trauma specialist. The knee became less swollen, but my foot was still dropping. It didn't feel like it was his responsibility. He asked for an X-ray, and in his opinion, everything had recovered. Luckily, I listen to my body, and everything I was being told didn't feel right. So I decided to get a private consultation for the nerve (300 Euros). Why private? It was the only way to get one fast. And why fast? Because nerve damage is harder to recover from the longer you wait without addressing it.

I traveled all the way to the west of Berlin. The doctor suggested doing an electromyography to see if my nerve conducted. I still remember the smell of my hair burning when she tried to increase the intensity because she couldn't believe what she was seeing. Luckily, her face showed this uncommunicated awe. She called her colleague to repeat the test. "She is better than me," she said. But the results were the same. The report? The nerve is kaput. The advice? Go to physio. A lot of people make fun of going to the doctor with a cold and getting recommended tea. Physio felt like the tea for severe nerve damage. Not something I wanted to deal with...

I went to the physiotherapist. She couldn't understand anything. "So you just fell running and your nerve is fucked up?" The trauma specialist gave me an Überweisung for useless 20-minute sessions where the physiotherapist would ask me to ask the doctors what to do, and ask me what I'd do considering the strangeness of the case. She was the first one suggesting I get a small orthopedic device to keep the foot at 90 degrees with my leg so that I could walk normally. She suggested getting a prescription from the doctor, so I did, but the lady at the orthopedic store refused to give it to me. First because the code wasn't right, and second, because she thought the Krankenkasse wouldn't pay her because they had given me and covered another one at the hospital. I couldn't believe it, and my mind was blown when the physio mentioned that I could just use a 15-euro one from Amazon. "Why are you wasting my time?" I thought. Also, why are they so hesitant to offer me anything because of fear of the health insurance not covering it if I need it?

Weeks went by. I noticed a bit of instability in my knee and no signs of recovery in the nerve. We went to Spain for Christmas and decided to pay for more tests myself. The first one was an electromyography, like I did in Berlin. The result? The same, no conduction. But this time the advice was very different and more acknowledging. "This is severe. Move fast." Finally! Someone who had called out the severity of the issue and urged me to move fast because it might require surgery. He also said that there aren't many doctors who know how to do these surgeries, especially if it requires transplanting nerve. It turns out there are cases where the nerve gets compressed and the surgery is about releasing it, but that didn't seem to be my case.

I then started my search for a trauma specialist specialized in nerves. I contacted two, one based in Barcelona with whom I'd finally get the surgery, and another one in Madrid. I got a very quick response from the latter, so I took a train to Madrid and decided to give him a visit. From the first moment I stepped into the consultation, I felt uncomfortable. He used sales techniques that I had seen before, from pressing fear buttons to coordinating with the hospital that would do the MRI later to continue the fear mood. The first MRI! After 3 months. That was the positive part of this visit. I could finally understand what happened. Hold yourself: I had, in practical terms, a dislocation of the knee, which resulted in severe damage to the LCL and PCL ligaments, and a couple of tendons that had detached from the bones. That dislocation had probably stretched the nerve beyond its limits, causing its internal fascicles to separate very severely.

Things started to make sense. I refused to do any surgery with that doctor who continued to make me scared to the point that I ended up crying. I was hopeful my conversations with the doctor in Barcelona went well. I went back to Berlin and visited my trauma specialist. I told him that I now have an MRI and that the reality is very far from his diagnosis. His response? "I have never seen this in my life, and if I were a couch potato like he is," he recommended not getting surgery. I couldn't believe what I was hearing. 32 years old, severely damaged ligaments, and your response is not to intervene?

I was then recommended through a family member to visit one of the heads of traumatology at the hospital in Bonn. My wife and I crossed all of Germany by train to visit this doctor. He confirmed the ligaments were not in good condition and would require surgery. However, he suggested forgetting about the nerve. To do a tendon transplant from the calves to the front side of the leg as a natural solution to keep the foot at 90 degrees. I was convinced about the plan for the ligaments but asked for a recommendation for a doctor in Berlin so that I could do the recovery close to home. And that's how I landed at Vivantes Kreuzberg with another head of traumatology there. On the side, I continued conversations with Joaquim Casañas from the clinic Traumaunit, who would end up doing both the nerve and ligament surgery, but more on this later. Note aside: this doctor from Bonn told his son, from whom I got the recommendation, that he was surprised to see that I was the one with painted nails and not my wife... Unbelievable.

But the story doesn't end there. My experience with the trauma specialist still feels to this date like a fake TV show. He started the conversation making jokes here and there, surrounded by a couple of extra guys. It felt like a boys' club. "What are you expecting out of this?" "Running again," I answered. Then he laughed and went with a "Running? Perhaps in the swimming pool, because you know you can run there, don't you?" All of this without looking at the MRI, which I was hopeful he'd examine, but that wasn't part of his plans. "Forget about the nerve," he said, then his colleague confirmed, and I stopped both of them and asked if they were neurosurgeons or had expertise on nerves. Surprise, surprise, neither was, but they had confidence as high as the Alps. So I decided to focus the conversation on the ligaments. "Do you know X?" (a German name) "No, why do you ask?" I sensed a bit of laughing over a funny joke. "It's a German player who played his entire life without ligaments because he focused on his physical health and strengthening the muscles that could take the role of the ligaments." And I was like, okay, but he is a football player, and I'm not. Then he looked at me and suggested that I focus on losing the extra kilos on my body, and if that wasn't enough, he looked at my wife and asked her if she liked me. Neither of us could believe the question, so she answered yes, and he gave her a recommendation to cook healthy food for me to contribute to my weight loss. We couldn't believe what we were seeing there; we were completely speechless. We also felt powerless. We should have said something and stopped the macho vibe in that room, but we were not emotionally charged to respond to that.

I was running out of options, but I knew the nerve was the focus, so I got an appointment with a neurosurgeon at Vivantes Friedrichshain, also head of department. This time, she spent some time looking at the MRI and trying to understand the whole case. She was patient and listened to us. However, the conclusion didn't give me confidence at all. "I think," she said, "that the issue is that the damage to the nerve is 20 cm, and considering nerves recover approximately 1 millimeter per day, you need to wait longer. I could open and transplant," she continued, "but it's always better if the nerve recovers by itself." In literal German: "Natur macht besser." The only problem was that in this case, nature couldn't do better because my nerve showed no signs of recovery in a few months, and it was on the path to causing the rest of the nerve to die and the muscles to die. That same day I had an appointment with the doctor in Barcelona, and he mentioned that the only way to know the state of the nerve was to open the leg and see. The surgery could just consist of releasing the nerve, or in more severe scenarios, it would require doing a nerve transplant, a very meticulous process where they need to identify what each nerve fascicle is for and suture them with a lot of patience and care. That's all I wanted to hear. Charged with many negative emotions, I decided to get surgery, which finally happened in February 2025, 5 months after the accident.

The surgery required a transplant as I originally expected. The nerve was severely damaged and wouldn't recover by itself. It took 5 hours, and everything that surrounded the transplant area looked positive. The doctor sent electric pulses during the surgery to confirm that the last part of the nerve was functioning and controlling the muscle as expected. It did, and he even recorded a video and shared it with me. Something that would have been unthinkable in Germany.

And that was just half of the equation and the most important one. The foot continues to drop and still drops because it'll take more than a year to control the muscle again, but everything is looking positive so far. But there was still the second half of the equation. What about the ligaments? In one of my checks with the nerve surgeon, who runs a clinic specialized in trauma, he got me an appointment with the doctor in charge of ligaments. He ran a bunch of tests, which he then contrasted with the MRI, and confirmed that my lateral and posterior cruciate ligament and the extensor apparatus would require reconstruction to bring stability to my knee. Otherwise, over the years, the tibia would get displaced and have cascading severe consequences. I was sold on it and didn't think twice about getting (and paying for) the surgery. I trusted the team from the nerve surgery, and I felt I was in good hands. Moreover, they knew my case, so they'd be extremely careful in this surgery to prevent any more severe damage.

But again, part of me felt that this should be covered by my health insurance in Germany, so I decided to give the system one final chance. I was recommended a trauma specialist specialized in sports medicine. I paid for a 300-euro consultation with this doctor. I went there, told his assistant my entire case, because yes, there they are so qualified that typing on a computer is a bit of a waste of time for them. Then he came, did a bunch of movement tests, less exhaustive than the ones I got in Barcelona (I could compare), and suggested getting another MRI. According to him, because you know... ligaments sometimes fix themselves. "Natur macht besser" again. I later learned that that's partially true. If the tibia is not fixated while the ligament damage heals, then it heals stretched and the ligament plays no role in protecting the knee. So his point was completely flawed. I was going to pay 300 euros for a 10-minute "get an MRI" answer, so I bothered him with a couple of extra questions. "So I come back with the MRI, and it shows no signs of recovery. What do we do?" Then he answered he'd wait until my nerve recovered, in maybe 2 years. A period during which my knee would be quite unstable and at high risk of causing other issues. I couldn't believe that was his suggestion. I said alright, I'll do that, but part of me knew I'd end up getting the surgery in Barcelona. I had no sign of trust from this trauma specialist, a very professional and respected one according to my physiotherapist.

Almost a year later, and after more than 30K in expenses, I've got the nerve transplanted, the ligaments reconstructed, and I'm starting the recovery process of the ligaments. It turns out none of the recommendations in Germany were right and would have led me to lifelong disability in my nerves and also my knee. I'm so happy that I made the decision to look for answers elsewhere, but this is unacceptable in a country like Germany, which I'd have never expected to have such a terrible system. At moments I thought I was unlucky with the professionals I came across, but I interacted with so many, and not just in Berlin, that I started to realize some patterns that are specific to the design of the system and that would explain why things happened the way they did. What follows is an attempt to explain these things. Because yeah... I'm a logical person.

The Why

I'll touch on a few ideas in no particular order.

I think Germany's health system is effectively private. For me, a public system is one that places the focus on the patient. The German system tends to the opposite. Why? Clinics get paid by the health insurance companies. They are companies, so they need to maximize their profits. They are limited in costs since they require a lot of human capital, and scaling the business would also mean scaling the cost, so they choose the path of maximizing the number of patients they see while minimizing the risk of over-prescribing and potentially having to cover the costs of some treatments that insurance companies would refuse to cover.

The doctor doesn't want to be in a position where they need to justify a treatment to health insurance. It's easier to prescribe you tea or skip an MRI because you were just running, and pass the problem onto you or someone else in the chain. The thing is that many serious health issues start with something small, so you need to take a more preventive stance and over-ask for tests that could uncover serious issues. In my case, an early MRI would have revealed not only the severity of the damage to my ligaments but also the connection with the damage to the nerve. Instead, the missing piece left a chain of professionals confused and passing the problem to the next ones, like middleware in an HTTP server. "I don't understand" > "Not my problem" > "Forget about it."

I later learned that nerve damage is considered high severity and treated with the urgency that I never had. I thought many times about private health insurance, but honestly, I don't think it would have done things any better. We say in Spanish that it's "the same dog with a different collar," meaning that at the end of the day, you are interacting with the same professional, just faster. The same professional who seeks profit over going deep into your case, like it was the case of the neurologist who thought the best solution to my non-conducting nerve was just doing physiotherapy.

Then there's the piece of not admitting that they don't know the answer, but at least pointing out the severity of the issue and the kind of next steps. Like... "I don't know, but I've heard this doctor is good at this type of surgery." I think it's a bit of a macho high self-confidence issue. This was a common denominator across all the male doctors I interacted with. One of them, the one who told my wife to cook for me to lose weight, felt like being in a boys' club. Listen, I don't expect everyone to know about everything. I knew my case was a bit special in that I didn't damage common organs, but I'd expect them to approximate closer to the issue and help me approximate even closer with the help of other professionals, but that was not the case. Instead, they laughed and hinted that I should treat my nerve as dead forever.

Another issue I noticed is that because German doctors perform fewer surgeries, they're losing practice and there's little appetite for exploring new techniques or treating complex cases. The system seems to discourage surgical intervention, which creates a vicious cycle: less surgery means less experience, which makes doctors even more hesitant to operate. I also heard from a nurse that a surgery that has a slight chance of not going as planned can impact a doctor's curriculum and reputation, so they are particularly hesitant in challenging cases. This risk-averse culture means doctors would rather pass on difficult cases than potentially harm their professional standing. In my case, this meant multiple doctors preferring to let me live with permanent disability rather than attempting a complex but necessary surgery.

Let's talk now about Überweisungen. Every interaction with a doctor requires explaining the entire case from the beginning. At times I felt I was a pigeon with Überweisungen from one side to another. The general practitioner was hesitant to give me those, the physiotherapist had interest in me getting more of those so that I'd have those useless 20-minute sessions and she'd get paid for them. The orthopedist store was happy if the doctor would figure out the right number to put on the paper so that they'd sell me the right instrument and my health insurance would pay them for it. The private doctors, both the neurologist and trauma specialist, sought purely profit, but when the problem was severe, they turned a blind eye to it. They even hacked the system. The trauma specialist knew he wanted to invoice me 300 euros, so he filled the invoice with a breakdown that didn't reflect reality. Is this even legal? Man... it's a recognized sports trauma specialist in the city, and he could barely hold 10 minutes going deep into the case?

And then there's the "I've never seen this before," like... yes, it wasn't in the book that you studied, but human bodies are fucking complex. Very complex. And sometimes issues span across boundaries, like it was the case here. Isolating domain experts like the German system does complicates treating health issues that span multiple areas of your body. Perhaps a pain in the stomach area is connected with some other part of the body, and looking at each in isolation would miss the big picture. I think the system is designed in such a way that it's easy to miss the big picture. The nerves are not the responsibility of the trauma specialist. Back to the doctor and paper to the neurologist. The trauma is not the responsibility of the neurologist, so back through your general practitioner to the trauma specialist. And all of that requires an insane amount of emotional energy that's difficult to have in such a situation.

What's Next

I'll take legal action. I didn't have the energy for that a few months ago, but I charged the batteries and I'll start working with some lawyers. I think there was a chain of medical malpractice here, and I think they need to assume responsibility. I don't want this to happen to anyone, and even though the way they act is a response to a system badly designed in first principles, if we silence these cases, there's little chance of things getting any better. Slowly but steadily, I'll start with this as soon as I'm back in Berlin.

As for what if something similar happens again in the future: I'll be pushy at every consultation with doctors. I will listen to my body like I did this time, and if needed, I'll add any drama necessary. The amount of taxes that are going to these things, something I especially see now running a company where I see health insurances debiting the money from the bank account, is insane and worthy of more than just 5 minutes of "go home and rest."

I won't switch to any private insurance because the doctors are the same. If they see me sooner but they are unable to tell me what I have, what's the point? I'd rather go to a place where I have the certainty that profit is well balanced with going deep into the case. I paid for the surgeries here in Spain, but at no time did I feel that I was a product. They treated me with great care and followed up before and after the surgery to ensure the best recovery. Isn't it annoying that this all has to be private? Oh yeah, it fucking is, and I'll fight as much as I can to change this, and taking legal action is a bit of my personal fight. We need to protect and improve the system, which we are covering with our taxes. If more than a thousand euros a month translates into not getting an MRI when I needed it, refusing to pay for an orthopedic device, a 10-euro invoice of copayment for the ambulance, or seeing me for 5 minutes to tell me to go home and rest, something is very fucked up.