“Listen well and deal with the other opinion”
Talking to Josef Widler, M.D.*
by Sabine Vuilleumier, M.D.
(27 October 2021) The renowned general practitioner Josef Widler expresses his concern about the rifts that are created between the “vaccinated” and the “unvaccinated” and presents his view on how to deal with the pandemic. – “Swiss Standpoint” talked with him personally.
We meet Dr Widler after the Swiss Federal Council tightened the Covid certificate requirement for the whole of Switzerland on 13 September. Anyone who has not been vaccinated, recovered or tested will no longer be allowed inside restaurants, theatres, cinemas and many other places in public and private life. Josef Widler does not agree with this: “I would have chosen the liberal path and left it up to restaurants, for example, to decide whether they want to demand a certificate from their guests or not. A landlord in a small village in the countryside has different guests than a landlord in the city. Innkeepers and guests would thus have been free to decide.”
Self-responsibility instead of fear mongering
For him, the self-responsibility of citizens is a central element in the management of the pandemic. At the beginning, he says, it was explained exactly what each individual – Mr. and Mrs. Swiss – could do to protect themselves and each other: keeping a distance of 1.5 m, no unprotected contact for more than ¼ hour, good indoor ventilation and a good hand hygiene – these are four measures that everyone can apply. However, this approach of what individuals can do themselves has “slipped further and further into the background”. “Today, the vaccinated tells the unvaccinated what to do and vice versa. But everyone should start with themselves and weigh their own risks.”
With this in mind, Josef Widler has also intensively trained the staff of old-age institutions he supervises – flyers with slogans would not help. In addition to the four measures mentioned above, he explained to everyone – from the nursing staff to the kitchen staff to the cleaning staff – that their behaviour in their free time determines whether they bring the virus into the institution or not. They understood this well and knew how to protect the residents from infection. Visiting bans and plastic shields only existed in the lockdown [16 March to 26 April 2020, edit.], Christmas was celebrated under certain conditions, also a summer party took place. His criticism of the way people are treated in old peoples and nursing homes is clear. He puts the human need for social contact in the foreground: “what good are the years of life if I’m not allowed to live them?”
Even though Josef Widler leaves no doubt that he considers vaccination against Covid-19 non-dangerous and effective, he wants to leave the decision to vaccinate up to the individual. In the interview mentioned at the beginning, he says that people who did not want to take the “royal way” of vaccination must be cared for in case of illness just as naturally as sick smokers or people who would drink too much alcohol. This corresponds to medical ethics, which in the treatment of patients does not ask whether an illness is self-inflicted and does not allow discrimination on the basis of a certain characteristic.
In contrast to the emphasis on self-responsibility, the Federal Council was leading by using fear from the very beginning and never left this terrain. Fear was generated with images of catastrophes – for example, the body transporters in Bergamo – and respective measures were justified with them. The first lockdown was certainly the right thing to do, because they didn’t know what to do at the time, but later they should have put self-responsibility first again. The issue of fear must be reflected upon by all those involved – including the Federal Council and the epidemiologists – in order to be able to move away from it.
* Josef Widler, M.D. (1954) is a specialist in general internal medicine FMH and ran a family practice in Zurich for 30 years. Since handing over the practice to his daughter, he has been employed by her part-time. He is the medical director of a hospital ward in a Zurich district and of a senior citizens’ residence. From 2005-2011 he was municipal councillor (CVP Christian People’s Party) of the city of Zurich, since 2015 cantonal councillor (CVP, now Die Mitte). Until 2003 he was Chief of Staff of the Airport Regiment 4. Since 2015 he has been President of the Aerzte Gesellschaft des Kantons Zürich (AGZ), since 2017 Chairman of the Board of Directors of AGZ Support AG and Aerztefon AG. He has three adult children and four grandchildren.
Good preconditions for constructive cooperation
It is clear from the lively discussion that Josef Widler is following the Corona pandemic and the measures taken by the Confederation and the cantons to combat it from a very broad perspective and is using his full “rucksack” of experience to make his contribution.
His points of view are well-founded and are not to everyone’s liking. He appreciates the discussion with his patients as well as with specialists and politicians in various committees. In doing so, it is important to him to talk at eye level. “First of all, you have to take in what the other person is saying and then deal with it.” He acquired tolerance and the critical examination of different points of view from good role models at the grammar school of the Stiftsschule Engelberg. Philosophy and the basics of the theory of science were important school subjects there, which he still draws on today.1
During his 30 years practicing as a specialist in general medicine in Zurich, Josef Widler acquired a great deal of specialist knowledge and skills in all areas of medicine. He gained leadership experience in the Swiss Army as a battalion commander and chief of staff of the airport regiment and, since 2015, as president of the Medical Society of the Canton of Zurich (AGZ) with its more than 6000 members. He confirms that the AGZ is in close contact with the Health Directorate of the Canton of Zurich, where it contributes the perspective of medical practice. In addition to his skills for constructive cooperation on the complex pandemic issue, he also has some political experience: as a municipal councillor in the city of Zurich (legislature at city level) from 2005–2011 and since 2015 as a cantonal councillor (legislature at cantonal level) for the CVP (“Christian People’s Party”, recently renamed “Die Mitte”).
Poor communication and cooperation with doctors
Much in connection with the pandemic had been communicated as if it were established knowledge. Josef Widler does not agree with this kind of communication: “if we are completely honest, we are short of reliable statements. For example: how long does the vaccination protection last? I’ll know that in 5 years, in 10 years – today they are hypotheses.” He argued the case with the Health Directorate of the Canton of Zurich to also communicate uncertainties, so you don’t have to retract later and the trust in the information given is greater. For example, that one calculates with half a year of vaccination protection and then checks whether that is correct, instead of saying that the vaccination protection lasts exactly 1 year!
He also sees a problematic side to the PCR corona tests: “the tests are not made to find healthy people. The pre-test probability is not taken into account: the more I can assume from the symptoms that someone is ill, the more reliable the test. The broader the testing, the smaller the probability of a correct result.” If a disease becomes rarer and rarer and is tested broadly at the same time, there are more and more people who test false positive and have to bear corresponding consequences.
His suggestions for a good contact tracing, the tracking of contacts of those who test positive, have been disregarded. The decision to allow doctors to test in private practice was made on a Friday – with testing to begin the following Monday. It was thus almost impossible to procure the protective material in time, and the practising doctors were once again put under pressure to act.
“GPs, psychiatrists, paediatricians helped hold the system together during the most difficult time – you rarely read that. We have carried the basic load.” The professional base was not involved in the political decisions. Josef Widler calls this the “helicopter effect”: “you don't see what is really happening down below, you have lost touch. To be able to lead well, you have to – as I learned in the military – listen well down to ‘the very bottom’ and include them in the decision making.”
He was not asked to join the cantonal pandemic team. The elected epidemiologists and hospital doctors were primarily concerned with ensuring that the intensive care units were not overloaded – which, incidentally, was not the only factor that allowed the Federal Council to prescribe the current measures in the existing “special situation” according to the Epidemics Act. With regard to the mortality from Covid-19, Josef Widler thinks that smoking should be banned rather than enforcing the current restrictions for the whole society.
Care could be guaranteed – and should be maintained
“We always had the pandemic under control medically – thanks to our expensive and well-developed health system. No one had to be turned away, care could always be guaranteed.” The preservation of the Swiss health system, one of the best in the world, is a matter close to Josef Widler’s heart.
The political efforts within the framework of the Federal Council's “cost containment measures” are a thorn in his side, as well as in the FMH’s, the federal professional organisation of doctors. Particularly objectionable is a “binding target for cost growth”, which corresponds to a global budget for outpatient services. If the doctor has “produced a certain amount of costs” – the description of medical treatments common among economists and health insurers today – he/she is not allowed to continue working in this case. This means a hidden rationing of medical treatments – not desired by patients.
In this context, the Medical Society of the Canton of Zurich, with its president Josef Widler, commissioned a study in 2019 questioning the population and the medical profession. The starting point was the observation: “For some years now, Swiss health policy has been limited almost exclusively to premium policy and cost-saving. There is a threat of health reforms that bypass people’s needs and demands.”
The study asked about the needs of the population and the medical profession on health care, whether the demands of patients and the offer of outpatient care match, and what the medical practice, the care landscape of the future, must look like so that patient needs are met and doctors find their way in this work environment, as well as the question of how this fits in with the trends and political plans in the health system.
One first finding from the study could be described as self-evident, if political developments did not endanger precisely this: “for a proper care, a good doctor-patient relationship and time are decisive for the population. Patients feel well cared for if their doctors take their concerns seriously, if they have enough time for consultation, if doctors look at their complaints from a holistic perspective, if doctors inform them comprehensively and involve them in treatment decisions. Thus, a majority of two-thirds would rather be involved in decisions than have the doctor take that decision away from them altogether.”2
There would be much more to discuss, but Josef Widler has to keep to his tightly scheduled daily routine. It is important that his reflections on how to deal with the pandemic meet with a more positive response in politics and that, as a result, social tensions can be reduced.
1 The Stiftsschule Engelberg is located in the central Swiss canton of Obwalden. On its homepage it states: “our pedagogy is based on our Benedictine tradition – we encourage our pupils to grow into personalities capable of conflict and consensus, ready to learn new things, throughout their lives. Especially through living together in the boarding school, we conduce an understanding – and commitment – to concerns of the community. This is an important goal for us in the personality development.” https://www.stiftsschule-engelberg.ch. – Josef Widler is president of the Altengelberg Association to help maintain the humanistic spirit – children from less well-off families should also have this opportunity for their education.