Easy Lesson: Going to the Doctor

Easy Lesson: Going to the Doctor

I believe one of the first major lessons I learned in Germany is "how" to see a doctor. Within days of my arrival I was sick and within weeks I had seen multiple doctors of various specializations. I learned the culture of going, from observing and listening while my husband advocated for me. I will say what was supposed to be routine care ballooned into three separate hospital stays, an emergency surgery and multiple follow up procedures. Lets say my case was an anomaly. However, with this series of unfortunate events I built up a consistent workflow of how to approach illness in Germany. I am not the person alluding to what it is like to gain an appointment or how it is im Krankenhaus. I am also not pretending to know everything there is about Versicherungexpialdocious. But I have been there and I know all too well.

One of the first questions you want to ask yourself is .... "How" sick are you?

Because slight illness isn't really a thing here. You want to be on your last leg when seeing the doctor. Why? Because minor illness even when treatable isn't going to be a priority in a German doctors office. Minor things like cold and flu really should be treated at home, at least at first, with rest and liquids including herbal teas. You can also consult the pharmacist oder Apotheke. If you simply can't get past it then you come for Open Praxis at the Hauspraxis. There you can be seen without an appointment typically same day. You may or may not receive care in a triaged, prioritized order so will be surrounded by other sick people for a duration you may not be able to endure. Monday morning at Open Praxis would probably be the absolute worst time to visit.

So I just walk into a doctor?

Yes, you simply walk into your local primary care doctor - a Hausarzt which typically works in or runs their own Hauspraxis. You should become a patient of record there so that they know you before you have a random popup visit. While your first time can be a one off, emergent care visit that office should explain that it is much preferred that you come there regularly by appointment. Your future appointments will be scheduled for preventative care, wellness checkups or any other non emergent medical needs like physicals, lab work etc.  So when you do wake up with an abnormal headache or have an allergic reaction they know who you are. You do not go to the hospital for things like cold or flu. You go there when you have impaled yourself, broken a bone or have gotten a burn. Now I cannot speak to babies and children, but I would hope open praxis is a thing in pediatric offices as well. For everything else you would either contact or walk into Hauspraxis and simply ask to see the doctor. Most of the time Open Praxis is between 7am and 9am daily. Some offices have it twice a day or offer after-hours solutions. If your Hauspraxis closes for the holidays or is remodeling they normally provide a number of alternatives within walking distance of their location.

If you just want a check up ... Okay you need to make a Termin for that.

If you would like to be seen by the doctor at a later date you will need a appointment or Termin. You can ask for that in the same way you would a Berliner at the bakery. There will be discussion around your name, birthdate etc. The person on the other end the phone or in front of you at the front desk will ask your preference for times and dates in consideration with their opening hours and availability. It will go a lot like back home but you will typically be seen within the next 24 to 72 hours not the usual three to four weeks out. Now it can get like that with a specialist or unique practice. It can also depend upon what insurance you have. I have been on both public and private plans here and had similar turn around but most people say privat care has longer waits to be seen. I think this depends on your doctors location and overall popularity. 

Where do you find doctors?

Well from what I have seen you simply stumble upon them. You can also just search by distance on Google Maps. Most seemingly residential streets are lined with offices of different sorts of medical practices and they will have signs listing specializations, opening hours and a contact number to be reached to schedule an appointment. I prefer to drop in and ask questions. This way I can see if the office is decent, the front desk staff is cordial and of course if the waiting room is busy or dead in the water. I like a happy medium so I know when and if I go there I am not going to be waiting for all eternity to see the doctor. You may also have resources via your insurance company but a lot of those are short lived, out dated and slow. More on this in a future post. There are also online resources, some being geared towards English speakers and expats and I will not discuss those here. I do however recommend Doctolib and praxis' that use it. Doctolib is a great online appointment setting site and doctors that do participate in this seem to be more progressive about scheduling appointments in a modern age. But good ole word of mouth is typically how Germans and expats alike find doctors that meet specific needs like speaking English. So ask your friends and family and you may find yourself in better and trusted hands.

You have an appointment or you go to Hauspraxis ... What is the wait time?

Typically waiting times for a doctor are the only thing not remotely punctual in Germany. So you probably want to arrive at your appointment time versus earlier and of course never late. Germans have a culture of arriving at check in, entering the Wartezimmer aka waiting room and announcing their arrival with a loud, formal greeting to everyone there. I wondered why they would be so warm in such a cold environment but as it turns out they are simply giving an audible cue for who is next. This way we all know the guy in the blue shirt arrived sixth in line for lab testing. You will wait so damn long you will keep your eyes plastered on the guy in blue to know when you may be called whether that is before or after him. If you are too busy playing on your phone to care an Oma will gladly assert herself for you. If at some point the nurse incorrectly calls someone out of turn in open praxis Oma will say blue shirt is now, you are after him and then her. I have waited more than three hours in open praxis before. This place was multiple train stops and a quarter of a mile walk from home. I now utilize a doctor directly across the street from my house. I don't live in a residential area so my visits are short and swift. I have never waited more than twenty minutes tops in my current Hauspraxis and with appointment I never wait at all. I do partake in the Wartezimmer culture of announcing myself for pure ulterior motives when going elsewhere though.


So what is it like at the doctors in Germany?

I hate to be the bearer of bad news but it ain't all that great! It really does depend on your insurance and the overall reception of your provider. There have been plenty of places I walked out of before ever being seen. I've abandoned ship due to wait time, a nasty restroom or a snide remark from a receptionist. Sometimes the front desk can be a tad intimidating as you will find a lot of these people are older and super conservative. These Heidis aren't very inviting to Ausländers or people that don't fit their ideals for prospective patients. I have found that I am more acceptable when my German husband accompanies me or I stick to Deutsch even if broken. Once I get beyond that in my experience the doctors themselves aren't really into bedside manners or pain management. You will find most doctors here do not like having their time wasted and they show it. So if you are always coming in for minor illnesses they will rudely suggest a lifestyle change like losing weight or adding in more vitamins to stop wasting their time. That is NOT actual inquiry and or treatment but a typical German doctor believes it is. You MUST advocate for yourself in Germany because there is no urgent care or self care route. You cannot go get cough syrup at 3am from Walmart anymore so if you feel you are truly sick when you are face to face with your doctor you must be adamant about how you feel and that you need their help. What I will say is you may find more compassion as well as urgency in a non-German doctor and that is relatively easy to find if you are apart of a community that seeks the same. Having a Turkish, Persian or an Ethiopian doctor can change your entire experience even if they are born and raised in Deutschland. Their lineage and or studies gives them a totally different outlook on patient care, pain, reception etc. This can be life changing for a lot of people who just can't stand a Deutsche physician but keep in mind most staff that is front of line will be German!

What should I expect at check-in?

The only thing a front desk member of staff should ever request from you is your insurance card. If you do not have one they should offer to bill you or provide an invoice that may be paid at a later date. If your insurance has some sort of additional payment for a specific service it may be discussed but never demanded at once. Unfortunately, you may be bullied by front desk staff who assumes you may not be able to pay and they will throw out an amount that is actually laughable. I recall being demanded to pay 35 Euros because I had no insurance. Then when I offered my credit card because I typically do not carry cash I was told it was required I pay with cash or EC karte. At this point I had already been seen by the doctor, no one was holding me hostage and I didn't understand that once you are done with the doctor you can simply leave. There typically is no check out process at a German praxis. I offered to visit a nearby ATM to pay them cash and returned rather quickly with their measly 35€. Later my husband informed me that this exchange should have never occurred. Of course, you will be given forms to fill out and I would say bring someone to assist you with those if you need help. I have also had members of the front desk offer to fill in my forms for me. I later realized they did so with assumed and erroneous info. Be aware Germans will assume horrible things about people with brown skin if you do not tell them otherwise. So double check everything you okay or sign off on. There will always be a brief disclaimer about patient privacy and billing measures too. Then you will be asked to go into a waiting room away from medical personnel versus a waiting area like in most American medical facilities. Of course there will be a place for coats, bags etc and most people will sit quietly until called to be seen. Do not expect a TV, fish tank or a coffee machine!x

What to expect once called?

You may be triaged by a nurse or practitioner while waiting for the doctor to arrive. A lot of offices will ask your height and weight rather than taking it. Of course this will be in the metric system so be prepared for that. When the doctor arrives they may utilize an office for a formal consultation. The office is usually a pass through before a typical examination room. So you and whomever accompanies you may be asked to sit in front of the doctor to discuss your symptoms. They may offer you water, coffee or tea. They may ask questions around your health and or family history. They may reach across the desk and began checking your vitals themselves. They may also stand over you while seated in the chair and check you with instruments or their bare hands. This may feel unusual but consider your symptoms may still be visible this way and only require a discussion. If they feel they need to investigate further they will guide you to the examination table or another room completely. You may move multiple times from the said office, the examination room and a room just for lab testing or an ultrasound. However, it is not unusual for most appointments to be completely touch free and over before you feel treated. Do not be alarmed by this. This is perfectly normal especially for cold and flu symptoms and the doctor may say they do not wish to touch you to stop the spread of germs.


So what is it really like at the doctor?

Well there is no privacy. Your initial discussion of what is bothering you may be made in front of other patients or with the door wide open. Your forms may be left out for others to see. Test viles of blood and cups of urine may also be front and center. When in a room you may not have adequate privacy for undressing or covering up. Ladies will not be given gowns or sheets for routine Frauenarzt appointments. Men may be fondled by young women instead of an old man for testicular or prostate woes. You may not have a nurse in the room to accompany the doctor. Old methods like pulling teeth without Novocain and putting two fingers up the butt for colon care are a thing in Germany. I have had my blood taken in a hallway full of file boxes. I've have been told to prepare for surgery by shaving myself completely and using a suppository pulled from a white coat pocket all the while in a lunch room. I have had two women hold me down and catheter me before I could decide for myself if I wanted that. This is the sort of stuff where you just want to go home. And sadly this is just German medical care. It can be rather primitive and brass. It will take some getting used to and you may even wish to avoid things you know will be uncomfortable and painful. But again you cannot self treat yourself in Germany and there are no resources. So you sort of have to endure the German ways. And trust me you want to do the best you can to ensure you never wind up in one of their torture chambers they call hospitals aka Krankenhaus.

How are the hospitals?

Horrible.

Most German hospitals are stuck in the past. They are also similarly understaffed and overwhelmed just like in the states. If you add in old medical equipment and a general lack of manners you are destined to feel or be mistreated during your stay. The antiquated ways of not offering a slither of creature comforts like socks, tissues, water fountains etc and not having air conditioning or chewy ice make you just want to scream. If you have a scheduled stay for a surgery or procedure it is expected that you or your family provide your toiletries, bath linens and anything outside of their horrid meals. If you find yourself in emergent care lets hope you had time to notify someone to bring you whatever you need post survival. I have had the terrible experience of being in the same pair of socks and underwear for days on end simply because it wasn't communicated to my loved ones what I needed and I couldn't speak for myself. Out of a dozen nurses I was finally offered some items including a gown, soap and a towel which was provided by a local charity. Of course I took this but I was absolutely mortified having to. So going forward I watched other patients "check-in" with an army of family and multiple suitcases as nothing but sheets and warm bubbly water will be provided. Do not even expect as much as a travel toothbrush, generic soap or gratis WLAN. Most hospitals offer a paid program for guests with extended stays for wifi access. If you have the ability to pre-register you will probably be advised about this additional cost outside of insurance or out of pocket costs for care. I am certain if people begin to engage with these posts in comments I will be berated by Germans and loving expats who will claim insurance or my general disposition or attitude warranted my experiences. Well I have been hospitalized a total of six times at five different facilities and my husband had a procedure at another hospital where he stayed over a week. I have seen how this plays out with all levels of insurance as well as "dispositions". It is NEVER good. So please do not lecture me about German hospitals ever.

Why is it like this?

During my longest stay I befriended my nurses and they were very candid about why things were the way they were. Unlike American hospitals Germany doesn't have major hospital systems that are for profit and constantly upgrading with philanthropy. Germans don't donate so there are no large endowments coming in to remodel wings and provide constant services like 365 air conditioning and a la carte room service. Most hospitals are independently ran by churches who do receive tax breaks but pay their staff minimal wages and keep operating costs low. There also isn't a culture of overpricing services and having urgent care where services need to be running 24/7. There is no gift shop. Concierge is never manned. Yes the elevator has been broken for twelve weeks. The doctor treating you is usually teaching other students and volunteers while monitoring your care and those under him are not making the big bucks. There is zero accountability or incentive in being good to you as a patient. The ones that are actually caring and motivating are simply doing it out of the kindness of their hearts. So you will have more mean nurses and tired doctors than you will ever encounter in the States. And in all honestly which would you prefer? Would you rather a nurse who is uneducated and driven by pay who is all smiles because donors are in the wing today or a nurse who has been studying since age 15 who has given herself to medicine? All I can say is befriend your nurses and if you do that they will provide better care and advocate for you to their teams. Of course this requires great patience and knowing the language. So with that being said throughout my medical history my experiences have gotten substantially better. But I still do whatever I can to avoid being sick while in Germany.

So how can you stay far removed from the medical system and its pitfalls in Germany?

Do as the Germans do! Embrace getting out into fresh air, bundling up in cold weather, exercising regularly, drinking enough water and having “whole“ diets. Most Germans pride themselves in eating well, avoiding sugar and taking supplements. A good doctor will recommend vitamin D in Deutschland as it stays dark most of the year. You will see a lot of teas and herbal remedies in grocery stores and drug stores. You will witness Omas going into Apothekes without prescriptions to be filled because they are simply discussing their ailments with the pharmacist before resorting to going to Hauspraxis. When in closed spaces open the windows or cover your face to avoid airborne illness and viruses. And of course keep the kidneys warm and be mindful of regularity. Germans are very transparent about this and they generally avoid having constant UTI's, incontinence or bowel related issues just by dressing warm and eating right. But have a Hausarzt and Zahnarzt aka Dentist nearby within a five mile radius of home so if you need care you can get it.

Oh and how is the Zahnarzt or any other specialized care?

Ah that may warrant another blog post (now available here). The Dentist is a scary one in Germany as they all do not subscribe to pain management beyond local anesthesia or OTC ibuprofen. I would suggest arriving intoxicated and or heavily self medicated just for basic exams let alone basic dental work or an extraction. Ask a lot of questions and be clear about your language proficiency as I have had a dental plan billed to insurance without any discussion around cost and had a tooth worked on about six times and as it turned out it was the tooth behind that one! Now like my Turkish doctor and Greek GYN have a Polish dentist. I have only seen a few specialists including an urologist, an eye doctor and a HNO aka Ear, Nose and Throat and I can assure you I will not being going back to any of those. As for getting into those offices most require a referral which is known as an Uberweisung similar to the term used in German banking. The Hausarzt usually provides this but I have had in example my Frauenarzt provide an Uberweisung for the Kinderwunsch Klinik. Other weird quirks may lead to a Hauspraxis "allowing" you to see a Psychologist or a Ortho. But in most cases you can find a Specialist who fits your needs on your own and simply ask your Hauspraxis for an Uberweisung for that specific person. You can also seek out holistic or Eastern medicine as an alternative. Most practices that engage in this do not accept or require insurance, referrals or any interference to begin treatment. However, most Germans do not regard alternative medicine with high esteem. I have considered seeking one for my dietary needs as clinicians that equal as dietitians are far and few in the public offering. I ultimately decided against it as every appointment would have been over 100€ with or without results. So proceed with caution with the bush medicine practices as you can do that just going to your local Reformhaus for herbal remedies. The same goes for acupuncture, chiropractic services, massages and or podiatry. You can get this without hassle but at your own risk and cost.

What about prescriptions?

Most prescriptions in Germany are low cost or free. Indicators of cost will be obvious in the color paper your Rezepte is printed on. Red paper typically signifies under 10 Euros or free, green slightly higher and brown, blue or white an out of pocket cost. You will physically take these to be filled as patient records are physical paper and there is no sending in your medications. Some doctors also provide things like topical creams or liquids in office. Regardless, you doctor will provide instructions on how to take the script but ultimately the Apotheke will consult you on actual dosing. So you can ask for a copy of your Rezepte or the Apotheke may write instructions out for you. Pretty much all meds are filled sort of generic unless what your doctor has prescribed is something brand specific. Most drugs in Germany are in tablet form, in blister packs housed inside of a box. Items needed to remain not packaged this way needing to remain dry or cold will be given a necessary thermal bag. Liquids and drops should be equipped with whatever tool you need to dose the medicine properly. If you need additional things like aspirin or ibuprofen you can buy a box of up to 40 pills without prescription. So it is up to you to ask your doctor in office for a 600mg or 800mg ibuprofen Rezepte, however most doctors will suggest you just take two or more 400mg capsules or flat out decline. You will never and I mean never be provided the opioids and barbituates America throws at everyone. Even if you have evasive surgery the most you may get is at 10 count 800mg ibuprofen. If you want to have things like Benedryl, Aleve, NyQuil I would highly suggest you take a trip to The Netherlands to stock up on those. They also have Sunday shopping so if you are SOL over the weekend especially if in a border city like Aachen your OTC pain management is less than thirty minutes west. Now of course you can ask the Apotheke for whatever you may not see and they can advise you what is available for OTC purchase which can and may include birth control, contraceptives, diet aids, first aid, ointments, antacids, pain and cold meds.

What about surgery or outpatient procedures?

Oh those function just like in the states. You will normally have multiple discussions and appointments to arrange this. There may be a pre-op orientation with a nurse and or anesthesiologist. You should be able to speak to your reactions and allergies. If you cannot do this in effectively in Deutsch please have someone who can speak English and Deutsch well to translate, fill out forms etc. The surgery itself is normally the long drawn out process of being moved from room to room. Then comes the waking in a fog with your loved ones nearby. And then exiting out of the rear with some assistance. This is typically all the same. However, if you must stay for observation especially in a Krankenhaus not a surgical or medical center be prepared with your own creature comforts as they may not be provided. I have personally experienced complications which lead to a brief stay in intensive care. The most compassionate care I have ever had was in the ICU but frankly I wasn't really awake to see it. But I did have people in constant contact with me to the point there was even a woman sitting near me to apply labello/chapstick to my lips because I couldn't. This gave me some hope in the medical system well at least here in Köln.

I don't mean to cripple you with fear about going to the doctor. I just wish to be truthful. I wish someone would have just laid it all out there for me. I miss my Obamacare and the ability to pay a co-pay and receive consistent care across the board. I miss actually looking forward to a dental cleaning or an out patient procedure knowing I would be treated to something pampering or relieving. The general sentiment in Germany is that you can't possibly know you are alive if you don't experience pain. Most Germans align with this as human right. So the notion that you seek medical care for comfort is strange to them. Medical care isn't comforting, relaxing, relieving or expected. It is more or less there if you need it and you get what you get. Now if you believe having access to a private room or more options for cosmetic services changes that sentiment then by all means buy into a private insurance plan that claims that. But the medical system in Germany doesn't revolve around the have and the have nots as it does in America. It simply does its own thing and you can pretend while paying more or less than your neighbor. Universal, single payer or public healthcare is all the same. You just have less people to fight over a bed and its quicker to die. I would much rather linger and get no-fall socks and cable television. I would also like to go in for care without high anxiety around mistreatment and pain. I get it. Germany doesn't want an opioid crisis and frivolous malpractice suits.  But in that greed and ignorance there is a culture of suffering that all Germans succumb to. In this I do not understand what is so great about suffering for the greater good. I would gladly pay to just be able to feel good about feeling better. And as of late I just feel better avoiding doctors completely while in Germany.

I'll talk more about medical records, insurances and overall cost in further posts. Feel free to reach out to me with any direct questions related to how to navigate the health care system while in Germany or to compare options similar to those in the States. I am no expert but I can try to help.