At the doctor’s

It is important to choose your family doctor (Hausarzt) carefully – they will usually be your first port of call when you have a health problem. Depending on your personal situation and preferences, various factors may play a role in your decision: 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. Some may prefer a male or female doctor, or a doctor who is older or younger.

If your German isn't all that good, you may want to choose a doctor who speaks your language. There are now many doctors who speak more than one language, especially in bigger cities.

You can search for doctor's practices in your area on the 116 117 website, filtering for specific qualifications, foreign language skills or accessibility options for people with disabilities. If you are dependent on sign language, you can also contact support groups for people with hearing impairments to find doctors who will be able to communicate with you.

Depending on where you live in Germany, it can be challenging to find a doctor. In some areas, doctors' practices may refuse to accept new patients or you might have to wait a long time to get an appointment.

In urgent cases, they can also help you to get an appointment with another kind of specialist. For this purpose, they will give you a special referral code that you can use when trying to get an appointment. You are then entitled to an appointment within four weeks.

The doctor's medical knowledge and experience aren't the only things that count; trust and mutual understanding are important as well. These factors may even affect the success of treatment. It is 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 take enough 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.

You should feel welcome and well cared for at your doctor’s practice, too. Not only should the practice be well equipped and easy to 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 as well. For instance, can you get an appointment at short notice? Are waiting times reasonable or do you often end up spending a lot of time in the waiting room even though you have an appointment? During what hours and in what areas does the doctor make house calls?

If you're not happy, 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 too – like needing to repeat some medical tests or having to share your medical history each time you go to a new doctor. A doctor who knows you and your family well is probably in the best position to assess your health.

Unless you need urgent medical treatment, it's usually better to make an appointment before going to the doctor’s – either by telephone or email, on the practice's website or through an appointment-scheduling app. 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 (offene Sprechstunde). You can generally 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 can't make it to an appointment, it is of course good manners to call and cancel in time. Some doctors may charge a 'no-show' fee if you don't, even though it's disputed whether this is legal.

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. Depending on how urgent it is, they may only be able to come after the practice has closed. Public health insurers usually cover the costs of house calls.

It is a good idea 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 beforehand. 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're on medication. So one of the most important things you can do to prepare for the appointment is to make a list of your medications, showing exactly which ones you're taking – including any medication that you buy without a prescription. This can help to avoid interactions between different medications.

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.

• If you have German public health insurance, you will need to take your electronic health insurance card with you in order to be treated in a doctor's practice. Should you forget it, you will be asked to bring it into the practice within ten days.
• If you have German 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're not insured with a German provider, but you have a European Health Insurance Card (EHIC) or Global Health Insurance Card (GHIC) instead, be sure to take it along to the doctor's practice – together with your passport or national identity card. There you will be asked to fill in a "patient declaration of European health insurance" form (Patientenerklärung Europäische Krankenversicherung), where you can enter the name of a German public health insurer of your choice. That German insurer will then settle the treatment costs with your health insurer at home.
• If you're insured in a country that has a social security agreement with Germany (Sozialversicherungsabkommen), you need to contact a German public health insurer before going to the doctor's. They will issue you with a certificate of entitlement (nationaler Anspruchsnachweis), which you should take along to your appointment.
• If you've taken out travel insurance or incoming insurance for your stay in Germany, you should bring those insurance documents with you.
• Asylum-seekers and refugees need a medical treatment certificate (Behandlungsschein) or an electronic health insurance card, which they will usually get from the social welfare office (Sozialamt).

If you've been referred to a specialist doctor’s practice, they will ask to see your referral slip (Überweisungsschein or simply 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 – if you have them – any important diagnostic results, such as x-rays or doctor’s letters.

Particularly when seeing a doctor for the first time, you won't only talk about your medical problems, but also about your life circumstances and lifestyle. It is important to be open and honest 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 figure out what's causing your illness, and to find the best treatment too.

If your doctor suggests that you need 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 that illness is. This also applies to any treatment your doctor suggests. You need to know what the treatment is expected to achieve, what it will involve, what you will need to pay attention to, how long it will last and whether it's associated with any side effects or other risks. Your doctor should tell you about any 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 more information.

If you find it difficult to follow your treatment plan – for instance, to take your medication as recommended by your doctor – it's best to contact your doctor’s practice immediately. You should never stop taking your medication or change the dose without consulting your doctor first.

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 examinations are paid for by public health insurers, including the U-Untersuchungen (standard check-ups for children and teenagers). Some screening tests aren't covered by health insurers, though. Then you have to pay for them yourself. While many screening tests are thought to be worth doing, it's not clear whether others (particularly those that you have to pay 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 can help you get treatment a lot sooner. But earlier treatment is only an advantage if it's 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 public health insurers. 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.

If you have any questions about check-ups or screening tests, you can ask your doctor. 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 special centers.

Many doctor’s practices offer individualized healthcare services, which are referred to as IGeL services in German (IGeL is short for individuelle Gesundheitsleistungen). You generally have to pay for IGeL services yourself.

They include offers such as travel vaccinations and assessments of physical fitness. Some public health insurers cover a number of these offers.

IGeL services also include things like diagnostic procedures and treatments that aren't covered by health insurers – for instance, because their benefits haven't been proven to outweigh the associated risks. From a medical point of view, many of these IGeL services are 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 don't have to have tests or treatments that are offered to them. If you don't think you'll 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, which is run by the medical commission of the German Federal Medical Service (Medizinischer Dienst Bund). Both of these are currently only available in German, though.

In Germany, medication is only available in pharmacies. If your doctor gives you a prescription for medication, you can hand the prescription slip in at a pharmacy – or have your health insurance card scanned there if it's an e-prescription (e-Rezept).

Prescriptions in Germany are color-coded:

• Pink prescriptions are for prescription-only medication. They need to be turned in at a pharmacy within 28 days. These prescriptions are now usually issued as e-prescriptions. You have to pay a co-payment fee (Zuzahlung) of 5 to 10 euros yourself for the medication. There may also be alternatives that you can get without a co-payment. You can ask the pharmacist about this option. No co-payments have to be made when medication is prescribed for children and teenagers under the age of 18.
• Green prescriptions are for medication that doesn't have to be prescribed by a doctor (over-the-counter medication). There is no time limit for when you need to turn these in. You will have to pay for these medications yourself – but some insurers will reimburse you after. If the medication is prescribed for children under the age of 12, public health insurers cover the full costs.
• Yellow prescriptions are for medications governed by the Narcotic Drugs Act (Betäubungsmittelgesetz), such as strong painkillers or medication used to treat ADHD. These prescriptions are valid for seven days. Public health insurers cover the costs of these medications, apart from the co-payment.
• Blue prescriptions are typically given to people who have private insurance. But they may also be given to people with public insurance for medication that has to be prescribed by a doctor but isn't covered by the insurer. Blue prescriptions must be turned in within three months.

Pharmacies also sell over-the-counter medications, like some kinds of painkillers and nasal sprays.

Sometimes a pharmacy may not have a certain medication in stock. They can then order it, and it can usually be picked up the next day at the latest. There are also online pharmacies (Versand-Apotheken) that send you medication in the post.

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 (Apotheken-Notdienst). The pharmacy charges a one-time fee for this special service per visit. In certain situations your insurer may reimburse the fee. You can find out where your nearest open pharmacy is by reading the information displayed at the entrance of your pharmacy. Alternatively, you can find that out by telephone or on the internet.

The above advice and information on how to choose a doctor and prepare for an appointment also applies if you want to see a dentist. There are sometimes special regulations for dental treatment, though. For instance, public 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 public health insurance are given a Bonusheft – either as a paper booklet or in their electronic health records (elektronische Patientenakte, or ePA). All the check-ups they go to are recorded there. If you have your teeth checked at least once a year and the 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 from the age of 12 need to have two check-ups a year to get this extra coverage (one in the first half of the year, and one in the second half). But younger children can also have free dental check-ups: Public insurers will cover the costs of one appointment every 12 months up to the age of 6 years, and then twice a year after that.

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 (Heil- und Kostenplan). 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 (Bewilligungsschreiben) includes information on how much of the treatment costs they will cover. When considering the different treatment options, particularly if they're expensive, it can be a good idea to go to a different dentist for a second opinion. You can also get information about dental prosthetics from public health insurers, the Independent Patient Advice Service Germany (Unabhängige Patientenberatung or UPD), and special patient information centers run by dental associations. People who have public health insurance can go to one of these centers to get a second opinion.