At the doctor’s

Photo of young man at the doctor's (PantherMedia / Chad Zuber)

When people in Germany need medical advice or treatment, their family doctor’s practice (Hausarztpraxis) is usually their first port of call. In most cases you are free to choose which doctor to see. Read on to find out what you need to know when choosing a doctor, how you can prepare for an appointment, and which medical services are available.

In Germany, general medicine, internal medicine and pediatric medicine offices are also known as “Hausarztpraxen” (family doctor’s practices). If necessary, family doctors may refer you to a “Facharztpraxis” (specialist practice) where the doctors are specialized in another field, such as gynecology, mental illness, or conditions affecting your ears, nose and throat (ENT). It is also possible to see a specialist directly. That applies to visits to a psychotherapist or child psychotherapist as well.

In some cases it can be a good idea to get a second opinion (see what a different doctor says), for instance if your diagnosis isn't clear or you're faced with a difficult decision about treatment options. You have a legal right to an independent second opinion.

Doctors, psychotherapists and people working in doctors’ practices must respect doctor-patient confidentiality. In other words, they're not allowed to share information about you with anyone else – not even your family members – without your permission.

How do I find the right doctor’s practice?

If you or someone you know are ill or need medical advice, a family doctor’s practice will usually be the first place to go to. So it's important to choose your family doctor (“Hausarzt”) carefully. Depending on your personal circumstances and preferences, different criteria will probably be important to you. For example, families and older people might choose a doctor’s practice close to their home because the doctor is easier to reach and may be more likely to make house calls. People who work might find it more convenient to choose a doctor whose practice is on their way to work. Others may prefer a male or female doctor, or someone who is older or younger. As well as sound medical knowledge and experience, trust and mutual understanding are important too. These factors may even affect the success of treatment.

It's important to have an in-depth talk with your doctor the first time you meet so that you can get to know each other. A good doctor will make the time and listen to you carefully. Your doctor should also be able to clearly explain the examinations you need and what your treatment options are.

If your German isn't all that good, you may want to choose a doctor who speaks your language and possibly has a similar cultural background. Particularly in larger cities, many doctors now speak several languages or have a different cultural background.

If you are dependent on sign language, you can contact self-help organizations for people with hearing impairments to find doctors who will be able to communicate with you.

You should also feel welcome and well cared for at your doctor’s practice. Not only should the practice be well equipped and offer barrier-free access – it is particularly important that the people who work there are friendly and helpful. For many people, the practice’s opening hours and how well it is organized will play an important role too. For instance, can you get an appointment at short notice? Are waiting times reasonable or do you end up spending a lot of time in the waiting room even though you have an appointment?

If you're not happy with your doctor, you can switch to a different practice. But it may be worth bearing in mind that it can take some time to build up a relationship with a doctor. Regularly switching doctors can have drawbacks – like needing to repeat some medical tests or having to retell your medical history each time you go to a new doctor. A doctor who knows you and your family very well is probably in the best position to assess your health.

How can I prepare myself?

Unless you need urgent medical treatment, it's always better to schedule an appointment before going to the doctor’s. This can help to reduce the time spent in the waiting room, and makes it easier for the practice to organize everyone’s appointments. Most practices set aside a few hours every day for people who come with acute problems (“Notfallsprechstunde”). You can usually come in without an appointment during those hours. But it's still a good idea to give them a quick call beforehand to let them know you're coming.

If you, your child or another family member are too ill to go to the practice, you can ask whether your doctor can make a house call. But it's not always possible for the doctor to come right away.

It's important to go to the doctor’s prepared. The better you can describe your symptoms, the easier it is for the doctor to find out what's wrong. This involves providing information about your general health, previous medical conditions and treatments (your “medical history”). It may help to jot down a few bullet points. You can write down any questions you want to ask the doctor so you don't forget anything important.

The doctor will also ask whether you are on any medication. One of the most important things to do before going to the doctor is write down exactly what medication you take, including over-the-counter medication. This can help to avoid possible drug interactions.

To receive treatment in a German doctor’s practice, you will need a valid health insurance card (“Krankenversicherungskarte”) with an electronic chip. Should you forget it, you will be asked to bring it into the practice within ten days. If you've been referred to a specialist doctor’s practice, they will ask to see your letter of referral (“Überweisungsschein” or just "Überweisung") when you get there. When you go to a doctor’s practice for the first time, you should also take along your certificate of vaccinations (“Impfpass”) and – where available – the results of previous diagnostic tests, such as x-rays or doctor’s letters.

If you have private health insurance, you will also be expected to take along your health insurance card or a letter from your health insurer declaring that your medical costs will be covered (“Kostenübernahmeerklärung”).

If you feel your German isn't good enough, ask someone to accompany you to your appointment so that they can help you communicate with the doctor. Should you need an interpreter, you will have to pay them yourself.

What should you consider when seeing a doctor?

Particularly when seeing a doctor for the first time, you will not only talk about your medical problems, but also about your life circumstances and lifestyle. It's important that you are forthcoming and honest when answering questions about things like your sleeping and eating habits, how much exercise you get, whether you smoke, or how much alcohol you drink. You might also be asked other personal questions and about possible emotional stress factors like problems in your relationship or family, or trouble at work. Your answers can help to find the causes of your illness and can also contribute to the success of your treatment.

If your doctor suggests that you have a certain medical examination, he or she should explain why. If you're believed to have, or are diagnosed with, a specific illness, it's important that you clearly understand what you might have. This also applies to any treatment your doctor suggests. You need to know what the treatment is expected to achieve, what it will involve and what you will need to pay attention to, how long it will last and whether it is associated with any side effects or other risks. Your doctor should tell you about other treatment options, and what could happen if you decide not to have treatment.

Do not hesitate to ask more questions if you haven't fully understood something or if you need further information.

Should you come to realize that you're finding it difficult to follow your treatment plan – for instance, to take your medicine as recommended by your doctor – it's best to contact your doctor’s practice immediately. You should never make decisions about discontinuing your medicine or changing the dose without consulting your doctor.

Screening, prevention and vaccinations

A lot of people don't just go to the doctor for acute or chronic medical conditions, they also go in for check-ups and screening tests. Many of these procedures are covered by health insurances, but others you have to pay for yourself. Whereas some are considered to be useful, it's disputed whether others – particularly those that have to be paid for yourself – have any benefits.

Screening tests are done to detect diseases at an early stage where they're not yet causing any noticeable symptoms. This may make it possible to get treatment a lot sooner. But that's only an advantage if earlier treatment is likely to lead to a better outcome.

Some tests are done to try to prevent health problems before they arise, by detecting risk factors such as high blood pressure or abnormal cells that could develop into cancer. This can be helpful if it's possible to reduce the risk of a health problem by changing your lifestyle or having treatment. Certain illnesses may be prevented in this way.

Another way to prevent disease is to get yourself and your children vaccinated. In Germany, most vaccinations are covered by the statutory health insurances. Some vaccinations are only needed once and last a lifetime (like the vaccine for polio), while others only protect you for a limited time (such as a flu shot). Many vaccinations can help prevent life-threatening diseases or diseases that may lead to dangerous complications – but not everyone needs to have every vaccination.

Doctors can help answer questions about check-ups and screening tests. Some of these can be done at your family doctor’s practice, while others are only carried out by specialist doctors, either in their practices or in specialist clinics.

What are “IGeL” services?

Many doctor’s practices offer individualized health care services, which are referred to as IGeL services in German (IGeL is short for individuelle Gesundheitsleistungen”). These include things like travel vaccinations and assessments of physical fitness, which you generally have to pay for yourself.

IGeL services also include diagnostic procedures and treatments that are not covered by health insurers, for instance because their benefits have not been shown to outweigh the associated risks. The medical necessity of many of these IGeL services is disputed. For example, the results of some diagnostic procedures aren't very conclusive, and they may have harmful consequences too. Detecting possible signs of a medical condition early on doesn't always mean that the condition can be treated more successfully as a result.

Because IGeL services are an additional source of income for doctor’s practices, they are sometimes strongly recommended and advertised in practices. But patients do not have to have tests or treatments that are offered to them. If you don't think you will benefit from an offer, you can turn it down.

If you want to learn more about these services, the German Medical Association (“Bundesärztekammer”) offers a general guide to IGeL services on their website. You can find more detailed information about IGeL services and evaluations of some of them on the website IGeL-Monitor.de, published by the medical commission of the statutory health insurance association ("Medizinischer Dienst des Spitzenverbandes Bund der Krankenkassen" or MDS). Both of these are currently only available in German, though.

Where can I get medication?

In Germany, medicine can only be bought in a pharmacy. If your doctor gives you a prescription, you can take it to a pharmacy and will be given your medicine after paying a limited amount yourself (co-payment). Pharmacies also sell over-the-counter drugs such as some kinds of painkillers and nasal sprays.

Sometimes a pharmacy may not have a certain medicine in stock. They will then order the medicine, which can usually be picked up the next day at the latest.

If you need medication urgently at night or on a weekend and your pharmacy is closed, you can go to a pharmacy that is on emergency duty. You will then be charged an additional fee for this service. You can find out where your nearest open pharmacy is by reading the information displayed at the entrance of your pharmacy or checking the website run by the Federal Union of German Associations of Pharmacists ("Bundesvereinigung Deutscher Apothekerverbände" or ABDA).

Treatment and check-ups at the dentist’s

The above advice and information about how to choose a doctor and prepare for an appointment also apply to dental practices. There are sometimes special regulations for dental treatment, though. For instance, statutory health insurers pay fixed amounts towards things like dental prosthetics. But these only cover medically necessary basic care. If you have special requests, like fillings or dental prosthetics made out of different materials, you will have to pay for them yourself.

Check-ups play a key role in dental care and going to them is rewarded by insurers: people who have statutory health insurance are given a booklet known as the “Bonusheft,” in which all of the check-up appointments they go to are recorded. If you have your teeth checked at least once a year and your check-ups are recorded in your Bonusheft, your insurer will cover more of the costs of dental prosthetics, should you need them. Children and teenagers under the age of 18 must prove that they've been to the dentist at least every six months.

Even though health insurers cover part of the costs, having braces or dental prosthetics such as a crown, bridge or tooth implant can be expensive. How much you will have to pay for dental prosthetics yourself will depend on various factors, including what kind of prosthetics you choose. Before any dental work involving prosthetics is started, the dentist will make a treatment and cost plan. This is submitted to your insurer together with your Bonusheft. In most cases your insurer will approve the plan. The insurer’s letter of approval includes information on how much of the treatment costs will be covered by your insurance. When considering the different treatment options, particularly if they are expensive, it can be a good idea to go to a different dentist for a second opinion. Information about dental prosthetics is also provided by statutory health insurers, the Independent Patient Counselling Service Germany ("Unabhängige Patientenberatung" or UPD), as well as patient information services offered by dentists. The latter also offer people who have statutory health insurance a consultation to get a second opinion.

Labels: Health care system, Health insurance, Hospital, Inpatient care, Outpatient care, Z51, Z71, Z92