Ortho & Physio in dialogue • Issue 01
"No patient is broken"
Berlin orthopaedist Max Fröhlich on why the way findings are communicated often unsettles patients more than necessary – and how doctors and physiotherapists can change this together.
A conversation by Somana
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6 min
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June 2026
Dr. med. Max Fröhlich, MPH
Specialist in Orthopaedics & Trauma Surgery, Berlin
Anyone who goes to an orthopaedist with back pain often gets an MRI and then a finding that sounds threatening: herniated disc, arthritis, wear and tear. But what if this very diagnostic process is part of the problem? Max Fröhlich belongs to a generation of orthopaedists who hold an uncomfortable view: often it is not wrong treatments that make patients sicker than they need to be – but widespread narratives around findings and a style of communication for which the system leaves hardly any time.
01
The narrative of the broken body
Somana
Which orthopaedic diagnosis is most often misunderstood?
Fröhlich
Disc disorders. There is this narrative: something has slipped out, become dislocated, broken. The back is understood in extremely mechanistic terms. Yes, there are herniations that can be understood mechanically – when nerves are involved, you have to act. But in most cases a herniated disc does not need a mechanical solution.
Somana
What should patients understand instead?
Fröhlich
The twist: yes, there is damage here, and it cannot be healed. That is the first shock. But: we can do very well at ensuring that you don’t notice it. My body is no longer intact, and it never will be again – but even so, I may well have no problem with it – especially if I take ownership of it. Far too few patients receive this message.
02
When words become a risk
Somana
In medicine we talk about nocebo effects – meaning that negative expectations can intensify symptoms. How self-critically does your profession deal with this?
Fröhlich
Too little. Anyone who uses fear as a basis for their argument – “if you don’t do this, in ten years you’ll have a back you can no longer move” – is doing something fundamentally wrong. It harms people. And as a doctor you become associated with the bad news.
Somana
What would be the alternative?
Fröhlich
Honesty without panic. Yes, you have facet joint arthritis. It can cause pain from time to time. But if you do something, keep your back muscles healthy, stay mobile, you have a good chance of rarely having problems. That is a completely different story from: you are broken.
Somana
What would you advise your colleagues?
Fröhlich
To handle nocebos carefully. Because if we send patients to physiotherapy full of fear and catastrophic thinking, the therapists have an unnecessarily hard job correcting that. We make their work harder before they have even begun.
„My body is no longer intact — but even so, I may not have a problem with that.“
03
The MRI trap
Somana
A provocative thesis: too much imaging makes patients sicker.
Fröhlich
With overly generous imaging, the harm can outweigh the benefit. Not only because of radiation exposure – but because you discover things that then have to be investigated further. Sometimes very invasively and expensively. Incidentalomas, incidental findings. Disc bulges are the classic example.
Somana
What role do reimbursement incentives play?
Fröhlich
A big one, it has to be said self-critically. The system sets the incentives wrongly: the MRI is well reimbursed, the honest conversation barely at all. Such incentives steer behaviour more than many people realise – even when an image brings no medical added value.
Somana
Why is so much imaging ordered nonetheless?
Fröhlich
Imaging is a means of replacing the time you don’t have. You can tell the patient: go into the tube. Afterwards they have the feeling that everything has been looked at. That replaces the conversation that would actually be needed.
“Imaging is a means of replacing the time you don’t have.”
04
A system that punishes explaining
Somana
Why do patients so often leave the orthopaedic practice anxious?
Fröhlich
Because orthopaedists get zero euros for explaining. You are massively penalised for it. Really, you should sit down for 20 minutes, go through the images, show a diagram. That would let you tell patients a completely different story from: you are broken.
Somana
If you could newly reimburse one service in the system – which would it be?
Fröhlich
The complex conversation. A consultation code: spoke with the patient for over 15 minutes. There should be something like conversational orthopaedics.
Somana
But physiotherapists do have that time – unlike orthopaedists.
Fröhlich
Exactly. There lies a huge opportunity. Physiotherapists spend far more time with patients than we do. They could take on the education that we cannot provide – explaining why movement helps, why the finding is not a catastrophe. If physiotherapy takes this role seriously, it can bring about behavioural changes that we orthopaedists, working in five-minute slots, could never achieve.
„There ought to be something like conversational orthopedics.“
05
The interface with physiotherapy
Somana
Where does collaboration between orthopaedists and physiotherapists most often fail?
Fröhlich
The aspiration to make patients competent is not trivial. It requires being outstanding both as a person and professionally. And the profession is undervalued – the reimbursement for physiotherapy is far too low. Collaboration, communication – the system makes no provision for it. What is wanted is: high throughput, treating the masses.
Somana
What kind of feedback between doctor and therapist would you like to see?
Fröhlich
Asynchronous. Via the electronic patient record – if I need something, I can look at the therapy report. Not constant phone calls. But if the course deviates from what was expected, a signal should come through.
06
What makes good physiotherapy
Somana
How would you define good physiotherapy?
Fröhlich
That people become competent at activating their own resources. Not: I need an external person to “put me back in place”. That overwhelms the healthcare system massively. I tell my patients in advance: after six sessions you should be able to help yourself and know how to prevent things getting worse – for example through long-term training.
Somana
What annoys you about feedback from physiotherapy?
Fröhlich
When patients come back and say: they did passive therapy, even though I prescribed active physiotherapy. Passive therapy has its justification – as a bridge to activation. Not as a permanent solution.
Somana
Why is that?
Fröhlich
Where a passive approach focused on “putting things back in place” dominates, dependent patients easily emerge – people who believe they cannot cope without treatment and come twice a week. That is not therapeutic success but cements the dependency. That is exactly what good physiotherapy should avoid.
Somana
And on the medical side?
Fröhlich
Here I have to be self-critical: We doctors often don't give physiotherapists enough credit. We treat them as people who carry out instructions, not as experts. Yet good therapists have a deep understanding of movement and load management — often better than we do.
07
More autonomy for therapists
Somana
Which tasks should physiotherapists be allowed to take on independently?
Fröhlich
For me it’s very clear: I make the diagnosis. The physiotherapist makes the treatment plan. If I say: upper crossed syndrome – then the physiotherapist decides which concept to follow.
5 quick questions
One sentence you never want to hear again?
Which exercise is underrated?
Which is overrated?
The most dangerous myth about arthritis?
What do physiotherapists think about orthopaedists?
Ortho & Physio in Dialogue
About
Dr. med. Max Fröhlich, MPH
Dr. med. Max Fröhlich, MPH, born in 1988, is a specialist in orthopaedics and trauma surgery at the MVZ Medicoleo at Potsdamer Platz in Berlin. He studied medicine in Münster, completed his specialist training at Vivantes and Johannesstift Diakonie, and earned a Master of Public Health at Leuphana University while working. In parallel he works as a Digital Health Strategy Advisor at gematik. In his master’s thesis he examined the future of digital healthcare.
Stay tuned for more interviews
This interview is part of the "Ortho & Physio in Dialogue" series by Somana – a series in which both sides have their say. None of the voices speaks for everyone. But each contributes to a better understanding of the interface. Further interviews will follow.
