Artificial intelligence in medicine: To the pharmacy instead of to the family doctor

Friday, shortly after 4 p.m. Niels, 47, a landscape gardener, approaches the counter of a pharmacy in Rotenburg, Lower Saxony, in his work clothes. He complains of an earache, probably a middle ear infection, and asks for something stronger. But that's only available with a prescription, and his family doctor has long since closed. The emergency room would remain at the local clinic, where he would now have to wait a long time. “I simply don’t have that much time,” he says. A six-day working week is normal for him. Pharmacist André Große offers him a video consultation immediately. “I’ve never heard of that before,” Niels is surprised.

After a short briefing, he sits alone in a cubicle in front of a monitor. A female figure asks him about his symptoms, how severe, left or right, emergency or not? Information such as chest pain, shortness of breath or visual disturbances can trigger a loud alarm so that no one simply leaves without being seen and falls over outside. Then Niels is allowed to tell stories freely; he could do this in 58 languages. No hurry, no one is listening. His health card is read in encrypted form and the data is only sent to the family doctor when he connects after about ten minutes.

The doctor doesn’t ask, “What’s wrong with you?” Instead, he summarizes the information, issues an e-prescription and advises Niels to go to a practice on Monday if there is no improvement. The whole thing takes less than 20 minutes. When Niels is outside, the next one is waiting: a mother with a restless child, acute symptoms, no doctor available, she wants to avoid the emergency room.

The female figure on the screen is an artificial intelligence called Symptox, a digital anamnesis assistant from Hanover-based Hanntech GmbH. The avatar is decidedly girlish. In psychological tests, says its creator Andreas Noack, most test subjects found this figure the most trustworthy.

Noack founded Hanntech in 2006. “I’m an inventor, not a developer,” he says. “We digitize analog processes.” The impetus for Symptox came from a pediatrician appointment with his daughter: Noack thought that the paper form for the anamnesis, a completely analogue process, should be filled out in a more accessible way. And the shortage of family doctors, especially in rural areas, “results in a shortage of resources: time”. With the medical history available, the family doctor involved can make a decision immediately.

Assisted telemedicine has been legally regulated since 2024, but the Pharmacists' Association and the National Association of Statutory Health Insurance Funds have not been able to agree on remuneration for a long time. The arbitration board decided in April 2026, the Pharmacy Reform Act came into force on July 1st, and the Symptox rollout has been ongoing since then. The family doctors log in for shifts. You first see cases within a 50 kilometer radius, but not which pharmacy they come from. Then they decide whether to accept it. According to Noack, there are currently around 300 family doctor offices in the pool, around 180 of them in northern Germany.

One of them is the Scheeßel general practitioner Jan Gerlach. He accompanied the rollout as a kind of pilot doctor. He calls the digitalization of medicine his “big hobby,” and that’s how he came into contact with Noack. “I’m taking part in Symptox because I already know the benefits from my own practice,” he says. Telemedicine is part of everyday life there.

During video visits in the nursing home, he connects with the patient and carer on site, and he has examinations streamed to the practice or to the home office. At the beginning there was sometimes a fear of contact; many feared that they would only be treated by robots or AI. The worry disappears as soon as he explains that the technology only supports the doctors and that a real doctor advises and treats. He asked the older people whether they could cope with it. Then he saw his 80- and 90-year-old patients fiddling with their cell phones in the waiting room.

For him, the network has a practical side effect: it helps him to better organize his own consultation hours in practice. “I can devote more time to the relevant cases.”

He knows that many colleagues are worried about the care of their patients. His attitude: The patient should be allowed to receive care wherever he wants. Some patients have problems getting into a practice, but there is a pharmacy in town. He advises his colleagues to get involved. With assisted telemedicine in pharmacies there are “really good opportunities to provide patients with compliant care everywhere in Germany”.

Around 300 of the almost 17,000 pharmacies nationwide currently offer Symptox, 30 in Lower Saxony and four in the Rotenburg district. So there are no reliable usage figures yet. The positive effect so far can be seen in the gap that Niels describes: acute complaints, closed practices, full emergency rooms.

Lower Saxony's Health Minister Andreas Philippi (SPD) considers the system to be sustainable and sees relief for practices and emergency rooms. His ministry refers to the on-call service of the Lower Saxony Association of Statutory Health Insurance Physicians, in which around 80 percent of cases have already received telemedical care. However, the state does not support pharmacies; it is a health insurance benefit regulated by federal law, consisting of a flat rate for technology that decreases over three years and remuneration for the work. In view of the pharmacists' investments in hardware for around 3,000 euros and in staff training, this is not considered unreasonable.

Criticism comes from several directions. The National Association of Statutory Health Insurance Physicians not only calls blood sampling and vaccinations in pharmacies, which have been officially permitted since July, “potentially dangerous” - its board member Sibylle Steiner considers assisted telemedicine to be “superfluous” and predicted in the Pharmazeutische Zeitung that it would not work.

Christiane Qualmann, chairwoman of the Rotenburg/Verden General Practitioners Association, criticizes the remuneration in particular: the reform deprives practices of fees that are used to finance services elsewhere; There will be “not more money, but money distributed differently,” said Qualmann.

For pharmacist André Große, however, it's about existence. The consultation is free for those with statutory health insurance, but the pharmacy receives 30 euros per procedure in the first year, then the amount gradually drops to 21.50 euros. Doctors get around 28.50 euros. “We can no longer live solely on the logistics of the drug.” A sensible alternative is “pharmacies as small health centers”, “like in Switzerland or other European countries”.

The e-prescription that the family doctor issued for Niels does not have to be redeemed directly at the Rotenburg pharmacy; the choice of pharmacy remains free. Not surprisingly, he redeems it with André Große. "It couldn't be quicker. Even if my family doctor had still been open," he sums up, "experience shows that I would have had to wait 45 minutes to an hour."

Andreas Noack's first assessment: It works and is being used, but the pharmacies are “not all at capacity yet”. Pharmacist Große suspects that it will still take word of mouth before the “Doc in the Box,” as he calls it, is established. The proposed requirement for a certificate of incapacity for work (AU) on the first day of illness could become a game changer. You could get the AU at the pharmacy without waiting or visiting the practice; the family doctors involved could issue it.