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Finding a Doctor

Choosing a doctor in Germany can be an intimidating process because of the language difference, but it doesn't need to be. The decision is of course as important as was choosing your doctor back home and can be approached in some of the same ways. You can refer to the yellow pages (Gelbe Seiten) in which doctors can be found by specialty. Or, often the best way, ask a colleague or friend. The best references can be by word of mouth. There are also several websites that list doctors by specialty or location. One such website has an English language search page: www.med-kolleg.de. Click on DocSearch on the upper left.

Other good sources are the university clinics (Kliniken) in major cities which provide outpatient services in addition to hospitalization. These clinics are staffed usually by highly skilled doctors who often speak English.

Some of the differences between medical care in Germany and America are the styles in which doctors interact with patients. In America there is a "Patients Bill of Rights" that doctors and hospitals must follow if they are to be approved by the American Medical Association. Under these rules patients must be advised of treatment, prognosis, alternative treatments, diagnosis and risks. German doctors have no such rules and may not be accustomed to discussing these things unless you specifically ask. So it's a good idea to come prepared to ask questions.

To help with the question asking you may want to bring a supportive person who speaks German or a seasoned colleague. And an English-German dictionary can be your best friend. It's helpful to practice questions and answers ahead of time.

Office Hours

Unlike the States, it's common for doctors here to have a private practice and be on a hospital staff. That's why office hours (Sprechstunden) may be more limited. Doctors in private practice usually have office hours Monday to Friday from 8 a.m. to 1 p.m. and then from 3 p.m. to 6 p.m., except Wednesday afternoons when most doctors' offices are closed. Although, you may have an appointment most doctors still serve patients on a first come, first serve basis and you may wait a long time to be seen. Primary care physicians usually have an "open door" policy but an appointment is still recommended.

Making an Appointment

When making an appointment either by telephone or in person, the first person you will speak to is the Arzthelfer or doctors assistant. He or she may not speak English but won't ask many questions about why you want to see the doctor. Usually you need only to request a day and time for an appointment. If it is for an extraordinary reason you may want to specify the reason for your visit. Otherwise, you can give your medical history to the doctor.

Some helpful phrases for an appointment are:

Ich möchte einen Termin machen. I would like to make an appointment, and

Es ist dringend. Haben Sie keinen fruheren Termin? It is urgent. Don't you have an earlier appointment?

If you wish to speak to a doctor on the phone before or after your visit, you must pay a fee.

Outside Normal Office Hours

When you have an urgent medical situation during evenings, weekends and holidays, there is always a doctor available. These doctors provide after-hours medical assistance.

You can find an "on-call" emergency physician by:

• calling your own doctor. If he is not available, he probably will have a recorded message giving the telephone number of an emergency doctor.
• calling the Notdienst (110 nationwide) or Artzlicher Notdienst for the name of a doctor in your area.
• going directly to the hospital or emergency room.
• calling your local police or hospital.
• checking your local paper.

To find the emergency doctor in your area thumb through your local paper looking for the heading Notdienst Kalender (emergency calendar) or Notdienste. In this section you will find the telephone numbers of after hour: Arzte (doctors), Zahnarzte (dentists), Augenarzte (eye doctors), Tierarzte (veterinarians) Apotheke (Pharmacies), Krankentransporte (ambulance service), and Feuerwehr (fire department). Some papers also list Alcoholics Anonymous meetings, AIDS help, therapists and taxi service. But this varies greatly depending on where you live.

Using this section of the newspaper can be an invaluable resource. However, because information varies depending on where you live, and because it is in German, it may be difficult to pick up and use, especially in an urgent situation. A strong recommendation is to become familiar with your local newspaper information by reviewing it in language lessons or with the help of a German-speaking friend. By doing this you will know right where to turn in many situations.

Hospitalization

Sometimes it will be necessary for you to be hospitalized. Only a doctor can authorize confinement for a non-emergency condition, and a principal difference between German and American hospitals is that patients probably won't be treated by the doctor who has been treating them up to now and who referred them to the hospital.

Germans, like Americans, are becoming increasingly concerned about the high cost of their health care system and, among other things, measures have been introduced to cut the length of hospital stays. Nevertheless, Germans usually stay in the hospital longer than Americans. New mothers, for example, average six days in a German hospital compared to one or two days, barring complications, for Americans.

Germans are not so concerned with privacy as are Americans. You probably won't be issued a gown during examinations, and there are usually no curtains around the beds. So bring a nightgown or pajamas and a bathrobe. Nor do German hospitals very often issue towels. You are expected to bring your own. Other items it is wise to bring: slippers, soap, toilet articles and a washcloth. Don't take too much, though, as storage space is tight.

Meals and mealtimes at hospitals conform to what's usual in Germany. The big differences Americans notice are the skimpy breakfasts and the fact that the big, hot meal of the day is served at midday rather than evening. Breakfasts will be rolls or bread with jam, honey, meat or cheese, while suppers will generally be bread, sausages, cottage cheese and tea. Supper is usually pretty early by American standards, perhaps even at 4:30. You are often given a choice of menus for your meals, and unless you're on a special diet you may keep your own food and (non-alcoholic) drink.

Visiting hours are usually from about 2 to 8 p.m., and German hospitals frown on visits by small children. You can get away with it, though, as long as other patients aren't disturbed. One parent usually can spend the night with a hospitalized child.

Smoking is prohibited in patient rooms. Patient rooms usually have two to four beds, and your roommates will always be of the same sex.

On departing from the hospital it is customary to leave a small consideration for the nursing staff. Fruit baskets, candy or baked goods will fill the bill, as will a "thank-you" card and €5 or €10 for the "coffee fund."

Pharmacies

Pharmacies (Apotheken) are generally closed evenings, Saturday afternoons, Sundays and holidays. Each of them has a list on the door, though, of pharmacies that have remained open to handle emergencies.

There are, in many cases, both branded drugs and less costly generic ones, and most of the insurance plans now will reimburse only for the generic ones. If the patient insists on a more expensive, branded version of the same drug, he must pay the difference out of his own pocket. Some drugs, such as laxatives and preparations to alleviate the symptoms of colds or motion sickness, are no longer reimbursed by the health plans.

Paying Up

If you are in the statutory system, you will usually present the doctor or hospital with a health insurance card, looking much like a credit card. The health insurance system then takes care of the bill. Many private insurers also issue a card with a "smart chip" on it. In the case of a hospital stay the bill may be submitted directly to the private insurer for payment. You'll receive a copy of the bill and may have to pay for some incidental expenses (telephone, TV rental etc.) Depending on the private insurer, for outpatient services you may have to pay the bill first and then, after submitting it to the private insurer, be reimbursed. Or you may be able to submit the bill to the insurance company and they may pay it directly.

American insurance may be accepted in Germany, but don't count on it. Check with them and get authorization before you start any non-emergency course of treatment. American companies usually also require that the bills you submit have an English translation. Some large German hospitals in the big cities will have special arrangements with Blue Cross and other large American insurers. But most hospitals don't, and expect payment up front from those who don't have German insurance.

It's important to note that the American insurance program for seniors, Medicare, is usually not valid outside the United States, though there are some Medicare supplements that provide some coverage. If you have elderly guests visiting, it might be prudent for them to take out special insurance for the duration of their stay.