Download Dr Pattni - Germany

Erasmus+ funded Hippokrates Exchange Program
Project no.: 2014-1-UK01-KA102-000412
Participant report
Seema Pattni– Germany – 1- 10 July 2015
When I received news that I had been awarded a place on the exchange scheme I
was delighted. I was excited to visit a new country and experience their healthcare
system. I believe that there is a lot to be gained from working abroad, not only for
personal experience but also to encourage reflection on one’s native healthcare
system.
I visited Weimar and Jena, in Thuringia, Germany. I had been to Berlin before but
had no idea what to expect about this part of Germany or what the healthcare system
would be like. It was a bit of a manic rush trying to organise a placement within the
time constraints of my job and the hosts’ capacities in Germany. However, the NEC,
Solvieg was very dedicated to it being possible and before I knew it, I was on the
departure flight.
My first presumption about Germany was contradicted as soon as i arrived: my
expectations of impeccable German efficiency were not qualified and instead, I was
met with several, severe train delays (a combination of train driver strikes, hot
weather and defunct train air conditioning systems). However, with my basic
German linguistics and the friendliness of a fellow female passenger, I eventually
made it onto a (moving) train and arrived in Weimar at 2am!
The next morning, I was greeted by Dr Seidel, a GP based in Weimar. He also runs
Infectious Disease clinics having trained and worked in this field for several years. I
felt lucky with this exchange already, I have an interest in Sexual Health and
Infectious Diseases, as I have worked in these departments and taken the Diploma in
Tropical Medicine. I spent a few days sitting in with Dr Seidel in both his General
Practice and HIV clinics.
On the first day, I soon realised that not only would I need to speak German, but also
Russian! Many of the patients in this area were from Ukraine, Siberia, Kazakhstan
and Russia - I had not expected to meet a patient from Omsk! That day we saw
patients with Kaposi’s sarcoma, Parkinsons Plus, cerebral toxoplasmosis, and some
more generic conditions: Cushings, pilonidal cysts, gout and tonsilitis. A lot of what
the UK would consider secondary or tertiary level work was done by Dr Seidel as part
of his HIV work, however, I think this was a unique set up given his academic
background.
Over the weekend, I took time to explore the beautiful city of Weimar, famous for
personalities such as Goethe and Schiller, as well as it’s quirky houses, painted in an
array of pastel colours, almost every house is the colour of cupcake icing! There was
also a heat wave, with temperatures of up to 38 degrees celsius, which made a visit
to the refreshing outdoor lido obligatory!
I then took a train to Jena and met my second host, Dr Stengler, a GP who has
worked in Leeds, England, for several years before moving back to Germany. She
very kindly hosted me in her apartment, which had a pretty good view of forests from
the roof garden.
This project is funded
by the European Union.
Dr Stengler’s working hours were, at minimum, from 7.30am to 7.30pm almost every
day. She works as a single partner but shares the practice building (but not patients)
with another GP, they cover each other only when one is away on holiday. Similarly,
to Dr Seidel’s practice, Dr Stengler's did not have a practice manager (finances were
managed by the GP) and the receptionists also did the work of health-care assistants
and practice nurses.
Clinics are a mix of pre booked and walk in patients. The consultations are not time
restricted per say but vary from a few minutes to half an hour. Multiple problems per
consultation seemed to be the norm! I observed less practice of the ‘Ideas,
Concerns, Expectations’ consultation model.
Other differences that I noticed early on in the second week were that there is no
QOF system, although there are targets set for chronic disease patients. Practice
lists are compiled differently, patients are counted per visit rather than per registered
patient. GPs are paid per visit and according to the complexity of the work done for
each patient on each visit, however there is a ceiling on payments for chronic
patients who will likely have multiple visits. A separate budget is issued to each GP
for medications, lab tests and physiotherapy referrals. GPs are expected to keep
within budget. There is no cost for referral to secondary care. Each GP has to buy an
existing 'seat' which serves a local community. Patients can attend any GP practice
but most affiliate with one practice.
Whilst in Jena, I took up the opportunity to join academic GPs at the Primary Care
Centre at the University of Jena, where I gave a talk on CCGs and Commissioning, I
had not expected the Professor of Health Economics to be in the audience!
After visiting the University and speaking to other trainees, I decided to read more
about the German healthcare set up. It is the oldest national social health care
system in the world, founded by Bismark in 1889. The funding is through a multipayer healthcare system - 7% from the patients salary and equal amount from the
employer. This is paid into Statutory Health Insurance. This is coordinated by not for
profit organisations which apply common rates for all members and entitle all patients
(who are issued with a personal insurance card) with the same access to care. Aside
to the statutory health insurance, if you earn over €50 000 per year you can buy
additional private health care insurance, 90% of the population is covered by the
statutory system. Hospitals can be private, state or NGO led.
Long term care in Germany is a notable feature. It works almost like a health
pension. In addition to the statutory fund, all patients contribute 2% of their salary, a
contribution matched by their employer, to save and provide long term care for when
they are elderly. Upon reaching a certain age, approximately 65-70 years, people
receive a lump some which can either be commissioned by their family for medical
care or it can be used it for a care home. Children are also means tested and
expected to help fund their parents health care needs.
Accident insurance is another feature of the German healthcare system. Accident
insurance is covered by the employer who will need to cover any risks, illness or
injury incurred commuting to work or whilst at work.
From a clinical perspective, another difference is that GPs in Germany do not cover
as much paediatrics, gynaecology or family planning, as in the UK. This is because
there are specialists working in the community who patients can consult directly or
via a GP referral; less outpatient work is carried in the hospitals because of these
This project is funded
by the European Union.
clinics. Specialists also provide out of hours care too, even psychiatrists. This lifts a
huge workload off GPs who manage more chronic diseases and elderly patients.
Acute home visits come in each day and GPs also organise planned home visits for
nursing home/elderly patients. Often the visits were to farm houses or quaint village
residences, the visits often ended with patients reminiscing about life in war time
Germany, during the Berlin Wall, or changes since reunification; as wells as gifted
box of home grown cherries or eggs from home reared chickens!
I speak basic German on a basic level and could understand most of the consultation
before the GPs offered translations. However, I think much of my understanding was
actually harnessed from non verbal communication: it was easy to register the
patient’s presenting complaint and their concerns was before any translation took
place.
Having my fluency in verbal communication removed, I was left to rely on other forms
of communication and this was actually a very good test to see how much I could find
out without discussing the problem with a patient. This experience was truly
demonstrative, for me, that so much of a patient's mood, anxieties and overall well
being can be drawn from their non-verbal cues, body language and behaviour. It was
always apparent when a patient was suffering from depression or anxiety, it was
even obvious when some patients were seeking a sick note!
I learnt a lot from this exchange and will take my learning forward with me in future
practice. It was also a great way to experience a different community and country
and provided an insight into working abroad. I fully recommend others to take up this
opportunity and look forward to more exchange opportunities and international
conferences.
This project is funded
by the European Union.