I Went to the U.S. für Medical Tourism

 

I Wen t to the U.S. für Medical Tourism

I am not ashamed to say I went back to the United States for medical care. I have been in a metabolic crisis since 2018 and German doctors are useless in my experience keywords my and experience. I don't have a so-called opinion that is drawn from inexperience. And now I no longer have to compare and contrast to experiences I had long ago. Drawing from memory, feelings or emotions about my past medical experiences and present opinions spark a nerve in many people, both Germans and Americans. It says that I haven't tried to cooperate with differences and exceptions here or let go of what I had access to back home. However, I have ten-fold cooperated. I have compromised. And ultimately I have become complacent with a medical system that works for everyone but me. Germany, their social medicine and their sort of doctors do not know what to do with me. Since I am still an American and I have nothing but positive experiences in the States with my physicians, insurance coverage and medical issues I figured I would give them a shot at helping me. I expected to compare everything but I was not prepared on the outcome of my journey - especially the costs. 

The major difference between here and there is bedside manners. 

It isn't everything when it comes to adequate and affordable medical care but it helps. Germany is a cold, bitter country and reception in any sector is not a strong suit. You cannot expect warm hospitality or niceties from anywhere or anyone in Germany. It is rare to be received with a hot meal, or a cold drink, an unexpected gift, a compliment or really anything at all in Germany. This picture says 1000 words. In it is a covered examination table and a gown - two things not to be found in general practices in Germany. My doctor in America is special. She is a family practitioner who also does internal and geriatric medicine. This allows her to take her time with her patients who need her to be thorough and patient in her workup. Most people interface with their doctors for 30 minutes. I was with my doctor and her nursing team for almost two hours. She looked at every single part of body down to in between my toes. Why? Because she is listening and observing what is and may be going on with my body. I haven't been physically touched by any physician in Germany in years. No one takes my vitals, no one takes me height & weight and in all interactions I am the one responsible for diagnosing me. A German doctor will listen, then agree or disagree, no more and no less. Even when seeking doctors who identify as something else and or have trained outside of Germany once here they are indoctrinated in a cycle of turning their patients like restaurant covers. While I know my American doctor, who I have seen since 2009, is an anomaly among all doctors - she is mine and she is a great example to look for when seeking a doctor who genuinely cares and wants to solve medical mysteries.

I am a medical mystery and no German doctor is willing to solve me. 

In America, doctors have training, experiences and more time to really analyze a problem. Surely, in America a lot of symptoms are medicated off the bat. But when a doctor listens to your history as well as your body they may actually get to the bottom of a problem. I have never felt like a German doctor has that luxury even those who are privat. All of these doctors seem pre-occupied with a list of cookie cutter diagnosis' for everyone. You will find people who will all say their doctor suggested, prescribed or wrote off the same things BEFORE doing any workup. I was hoping that even if I didn't have a lot of time in the States that my doctor who knows my body could physically tell something was off. I was looking for another perspective. I was hoping for whatever documents to support my claims. I was looking for a piggyback to a second or third opinion already received in Germany. Well, she was able to asses that the German doctors I had seen had done professional and thorough workups - at least on paper. But she was not able to solve my mystery. And for that she apologized profusely because if she had more time or could have had more preparation she may have been able to at least get close. She expressed that she felt she had failed me. And that confession alone made Germany and its entire medical community an afterthought. My American doctor really struggled with not being about to help me unlike a German doctor who would gaslight, ridicule and sometimes harass me for seeking answers to my problems. 

The dilemma for her was that so much had changed since I had been gone.

Insurance, coverage, permission, her support staff, her ability to do immediate orders and much of that had to do with me being a self pay patient. Because I didn't carry American insurance coverage nor did I fit a profile for assistance with my medical bills, I didn't qualify for things like STAT orders and referrals or in house lab work. Because of that things were delayed, sent outside of her practice or not able to be done at all. Again, she apologized for this because her hands were tied. And having my needs not met for these reasons didn't make me want to beat her while she was already down. Of course, it was disappointing but it wasn't the end of the world. I could go back with her labs, findings etc. I could also prove to my existing doctors and specialists that despite all of my cooperation nothing has changed. In fact, between her and the lab I now have more issues on record - things I thought were under control or already resolved. So I am still experiencing what I am experiencing and the people who know me cannot even figure this out. Maybe now German doctor will take me seriously? Maybe now I can get some real help because I have exhausted all channels. Maybe they will do everything I am asking because I invested in myself by going back home. Or maybe this will create more scrutiny and badgering? Maybe this was all a huge mistake. 

The total cost of my visit to my American doctor was around $800.00 USD ... so about 680.00€ (this does not include the costs of travel and accommodations)  

For the above, I got nothing I asked for.  I wanted a full metabolic blood panel. I wanted to interface with an endocrinologist. I wanted tests ran for pituitary, adrenal and cylindrical Cushings as well as Lyme's Disease, Hashimoto's and Lupus. I got similar blood work I have gotten in Germany but for double the cost. I had no facetime with an endo because my doctor was not allowed to refer or create orders for self pay patients. I got no endo tests because my doctor was not equipped to do them nor did we have enough time to convince an endo to do them without me being an insured patient of record. Was the above possible? Yes. If I were an insured, patient of record living in the United States of America. But because of my status now I was ineligible even if I paid full out costs for each test, procedure and specialist requested. Again, the labs they did do did provide insight on other underlying issues I have. So I have more mysteries to add to my list for my German doctors. And I am not looking forward to explaining this to anyone. Frankly, despite doing everything doctors have asked me to do a lot of what they suggested isn't working. I am deficient in a lot of nutrient categories and I am at my most unhealthiest despite having a good Hauspraxis team, a dietician and a few specialists who support that something else may be wrong. All of their suggestions to try this or use that, well America has refuted them and I am now truly lost on what I should do. 

I feel like I went home for nothing.

In both Germany and America, I have dealt with some of the most stubborn support teams who are gatekeepers to doctors. I am talking about front desk staff excluding nurses and practitioners. In Germany, while I have been so pleased with the doctor I now have the front desk manager is the epitome of evil. She speaks to me as if I am deaf and she does a lot of passive aggressive things to make me feel uncomfortable. I know what her problem is but because this office is technically not a German one they have adamantly denied my claims on her behalf. She refuses to mediate alongside of them with me and she has also said she will not apologize. Yet she remains on staff and continues to be obnoxious to me. While I didn't have to deal with this in America for obvious reasons there are still issues with front desk staff. My doctor has new staff and the quality of those individuals has declined. I contacted her office many times before my arrival to explain the urgency in what I wanted. Each time I was met with different answers and I believed what I was being told. At no point did anyone go and ask my doctor what she could do for me. So when in office and listing off my expectations, she exclaimed it was the first she heard of that and it was too late to try to meet my needs now. She asked did I ask them to speak to her or did I ask to speak to her directly. I did. Repeatedly. At the end of the day her support team was responsible for not giving my doctor what she needed to help me. I was okay with this because it was impossible for me to keep calling from Germany. I did the best I could do. I got the appointment three months in advance. I did everything I could from an online portal. I picked up my paperwork a day in advance. I fasted as advised. I anticipated costs as advised. Only to be told a different amount and that they couldn't do any labs or tests. By the time I left her office the lab they sent me to was closed. So I fasted again and spent three hours the next day at LabCorp. But her authority was obvious as she had forwarded those orders and I didn't have to explain myself again. In the two weeks I was there she contacted me multiple times via email and the portal to touch base about her findings. However, when I called back to her front desk they were a mess. I had left a lot of paperwork with them and they lost some of it. I stayed on the phone over twenty minutes trying to get something from them, they told me it was there and when I went to get it ... it wasn't. There was one common denominator, one girl, who seemed to be the monster of the group. I realized it was that particular girl who kept disregarding my questions when I called and who was quite obtuse the day I was there. Sadly, this sort of nonsense is universal in medical care. Clueless and irresponsible staff who operate like they run the entire establishment. This pushes patients away and limits the way patients interact with their doctors. In both Germany and America, what can I do to prevent this? Nothing! I just have to continue to deal with this to see who I came to see and hope they didn't interfere with my care. But after all that communication on my end that I no longer lived there, that my name had changed, that it was imperative things get done while I am there - no one listened to me. And it is the same here - lost paperwork, misunderstandings, waiting for obscene times when there is no need to wait. If I wanted more of the same but getting yelled at and directed to a waritezimmer full of sick people, I could have saved a lot of money and stayed here in Germany.

I expected a radical difference. 

For this reason, I kept my husband as far removed from this process. The last thing I wanted to hear was how Germany was better. What I can say is in most areas it is the same. I guess the only difference is the suffering. For me, engaging with German doctors, the medical system and the lack of options around self care just causes people to suffer. Had I had more time and more resources I could have found a Endo in America that would have seen me and the tests would have been done in a timely fashion - however at a cost. Behind the scenes, I had three people calling offic to get me seen while I was there. However, he and I  had bookings and reservations we had to attend to. I was going for medical tourism and my husband had other plans. I compromised. For him, it isn't important to keep pursuing these issues because he believes Germany will eventually help me. I do have appointments for now two Endos and allergy testing. But he has been present for those conversations that lead to appointments months and months out. Yet somehow he is overly confident that these delays and lack of urgency will lead to resolution. I have been waiting for an Endo consult for over a year now. I have yet to physically see one. The tests that have been done are not what I am asking for. And I have asked and begged and pleaded. And it is as if my health isn't a priority. I cannot pay my way into better care in Germany. There is no better insurance that will get me better care in Germany. In America, I know these things are possible. Is it fair? Of course not. But I know had I had the time and money to get what I needed I could have accomplished everything and then some back home. I know Germany will never provide that. I cannot bribe a German doctor to help me at this point and it pains me to know that even when incentivized these people still don't care. Ultimately it is about that because they are paid well, they are not inundated with patients and they know they can help me but choose not to. And above all no one holds them accountable for doing the minimum which is caring. My American doctor is in a group that is affiliated with a major hospital. All American doctors are. And they are held to the fire to meet expectations of both  their patients and the reputations of their hospitals. Most German doctors study, open a practice and do not have to report to any agency or entity for the remainder of their careers. There are studies that show how their level of care wains over the years and no one holds them accountable. There is no threat of losing a license or affiliation. There is no threat of a lawsuit or closure. Therefore, people suffer and even if they wish to self treat themselves, in Germany they can't. I am sorry, you can eat well, drink tea and supplement yourself to death. Those things don't cure obesity, infertility, metabolic disorders or cancer. You can die if your thyroid cannot regulate itself. And what is crazy is it is preventable but Germany would rather you suffer with it than do anything at all. My American doctor doesn't want that on her conscience and doctors here are more concerned about their lunch pauses, open windows and endless vacations.

 I do not know what motivates a German doctor because it surely isn't money. 

To prove my point, I went to an Endo which I have an appointment. First of all it was 9am on a Monday and that place was empty. So why am I waiting months to be seen? And no doctor in Germany thinks to fill their books when patients no show or cancel. They don't even call you if you miss an appointment. Secondly, I was met with a front desk receptionist that wouldn't even look at me. She was leaned back in her chair with her feet up. I spoke to her left shoulder and the silhouette of her face. Third, I asked is there anything I could do to make my upcoming appointment more efficient. I was told come when I am told and bring my überweisung. What is upsetting about this is more than likely when I arrive I'll be asked for things I cannot get in that moment. I am always told to bring my paperwork which is comprised of what exactly I never know even if I ask months in advance. Typically, instead of their staff calling, faxing and emailing (because they cannot digitally access records because there is no system for that in Germany - more on this in future posts) I will be the one made to get whatever is required even though I asked. And then I'll be told things cannot be done or completed until I do that. So therefore my resolution will be delayed yet again, my other doctors left in limbo and it is a continuous cycle of bullshit. My husband will then balk that I wasn't prepared but all I can ever say is I asked. At least in the U.S. regardless of my coverage or financial status I can expect that my important records be accessible. I can also use my phone to access my own things and forward them in the moment. Countless times I have been in front of a German physician and been told it was rude to attempt to contact another to get what they were requesting. It is as if everyone here prefers wasting time. And that is okay in terms of immigration and drivers licenses but my health is important and again I cannot pay anyone to understand that here. And never is there any apology or understanding. I am just met with poker faces and turned down lips about whatever hurdle that is put in my way after already waiting to be seen. Upsetting is an understatement. Frustration isn't the proper definition. Exhausted is more like it. And I am already tired, sick and tired so the above doesn't help me. As you can see this isn't opinion, it is fact. I cannot get adequate care here and we pay what I paid monthly for the above. Whether I see someone or not we are paying 600€+ for in my experience ...  very shitty care. So I pay either way but even with time and money I get nothing at all. And it isn't like the social aspect of what we pay is creating better care for someone else. Everyone is suffering while Germany profits. At least I would get something for my money in America. If I didn't see it up front it would be in my tax refund or negated with other pleasures of being there. I could go on and on. At this point, I have these appointments through November but if nothing changes I need to go somewhere that will help me. I guess next stop is Poland.