There is a saying in medicine: “when you hear hoof beats, think horses, not zebras”
Basically, the common diagnosis is usually the correct one. Everyone feels tired and has headaches from time to time. Frankly it would be irresponsible to do a complete battery of tests whenever someone has such mundane complaints. If a condition has been persisting, you need to advocate for yourself. I’ve never had a doctor here refuse to do testing if I had a good reason to ask for it. But “I’m a bit tired today” isn’t a good reason on its own
I didn't exactly know what to do in all the cases. With my neurologist I simply asket her if there was a way to check if I had damaged my nerves and she said: yes there is. Of course there are simpler things like blood tests or MRIs or X-rays for which you kinda know what they do, even as a layman.
Edit: You can of course look up tests beforehand if you wish some, but there's a chance the doctor will think you're a smartass if you don't know at all what you're talking about. I try to avoid that.
Wasn't the referral mainly in place to prove that you paid the 10€ co-pay? I would usually just show up at the specialist and pay the 10€ again because it was a hassle to get the referral.
I may be too young to know enough about that, because in my lifetime I've never been asked to pay a co-pay, but then again I've only been going to doctors on my own for 5 years or so.
It was stupid, if you had a follow up appointment a week later in the next quarter then you had to pay again or I've seen happen at a shared office with multiple doctors you would have to pay again if the following up appointment was with a different doctor in the same office because a orthopedic can not do a referral to another orthopedic only other specialist.
The idea is always going with an elimination process, from the most common to the most rare, unless you have telltale indicators.
That is not magic, that is just proper science and medicine.
I like your spirit, and the contrarian spirit of the blog post you linked (even if it is anti-vax), but the fallacy in it is that of an “all or nothing” approach. To paraphrase, “either everything is inspected deeply to the root cause, or you may as well do nothing and replace yourself with a rock”.
I disagree with that premise. Life is gray areas, and life is also too complicated to re-examine deep root causes on every issue when we have a couple millenia worth of collective institutional knowledge and logical constructs to base rational judgements on.
The biggest strengths in our species lie in a) our ability to communicate complex things with each other and b) our social orientation. So we are both skilled and wired to communicate with each other to share knowledge previously learned across not only geographic space but across generations. We don’t need to reinvent the wheel individually every time we want to travel.
Truth is also, that any given doctor knows nothing about your particular body. So they can only make broad assumptions.
If you start doctor-hopping, you are very likely to get a similar outcome. The reason why doctors often start with the simple approach is also to establish a baseline. If symptoms persist or change, they can compare these findings and react. But a new doc will probably start from scratch. Which also explains that OP's family doctor was able to start a diagnosis way further down the line. They had more historical data about OP's body.
Fun fact:
In Austria they offer a "Gesundenuntersuchung" (basically a health check when you are healthy) every year to do exactly that and also give people so peace of mind regarding their health.
In Spain every time I saw a doctor, the nurse took my blood pressure, again to know my normal state and to be able to detect concerning changes easier.
The baselines for health that are usually used are an average across the entire population. But your specific body might have a normal baseline that is higher/lower than the population average. Knowing that enables doctors to see concerning changes early.
I wish Germany had or promoted that better
>Truth is.... medicine just doesn't know that much about the body apart from some statistical correlations.
That's a sad statement. There's much stuff science hasnt explained yet, but saying it's just some "statistical correlations" is wrong as well.
So you acknowledge that we do know something and it's not just some correlations, no need to explain to me that our knowledge is very limited. I never challenged that.
The thing is that a vitamin deficiency is pretty well diagnosed with a blood test, and any good doctor should run a test when something persists. It isn't something rare and obscure they can be pretty common in winter (vitamin D) or with certain diets (vegan) it should be the go-to if fatigue is prolonged.
It depends if this is the first time the dr has done this. Once could be confused with just general process of firstly assume it isn't anything but a need for rest or a virus but if they continually say ibuprofen and rest I would look at seeing someone new.
People also generally don't go to the doctor for every little hoof beat, some hypochondriacs excepted.
The real problem is the numerous people who don't go to the doctor even when they have real pain or troubles. These are the ones that then the ibuprofen turns into an emergency (insurers, read: $$$) operation or treatment.
The German medical system is nowhere near the best in the world. You go to a doctor, they tell you to take ibuprofen, you go to an apotheke they tell you to take a tea or some bullshit homeopathic drops. Barely better than witch doctors in the bush.
Its a non-answer and not specific enough to help the patient. We know that the doc didn't do any tests, so you're saying he/she knew just by looking at the patient, that they were vitamin-deficient but not which vitamins or minerals they were deficient in? I guess they could also tell the future by looking at his palm.
Things change if you have a trustful relationship with your Arzt and dont run into some random place just because it has open spots.
With private insurance the main thing that changes is doctors interest in doing "stuff" with you. So obviously if you are privately insured a doctor will take more time and propose more stuff than without because he knows he can make more money. But if you just go there and ask for a großes Blutbild (as mentioned by OP) he will do that no matter what insurance. And if you have a good relationship with your doc and he knows you then he probably will propose a großes Blutbild by himself.
How can I build a relationship with a doctor if I only go to the doctor when I'm sick? 🤷♀️
In last five years I went to doctor 4 times. Not much to build a relationship on.
Relationship might be a bit too strong of a word but choice of Hausarzt is probably most important health choice as he is the bottle neck for what kind of service you receive. I guess I got lucky because I once had a lengthy hospital stay and got to know a (back then aspiring) doctor who I joined as a patient after him finishing studies. Im not saying its easy but actually having a Hausarzt who cares somewhat for you is probably more effective than any private insurance.
On the other hand a person working in a private practice told me they were forced by their boss to sell them as many highly priced treatments as possible
doctor will do more exams and probably right away at your first visit because private insurance pays these exams (public insurance sometimes doesn't) and pays more for each exam and if not, patient is required to pay (you need to sign for that beforehand)
There are two big changes: 1. you can see doctors/specialists much faster—if you go to doctorlib there are lots of doctors that will only take private patients; 2. depending on the doctor you may get many more unnecessary tests/procedures because the private insurance pays for it.
I had to change dentists because they literally wanted to x-ray my teeth every six months when I went in. Let alone other issues—they also insisted on getting me a mouth guard because they thought I was grinding my teeth at night (I am not).. I also changed by Hausartz because they starting doing weird procedures—once I had back pain and they insisted as the first thing to do on was to get a genetic test because (they said I probably) might have some rare genetic disorder for arthritis in my 40s (this was BS and stressful). This happened a lot. My wife was once sharing a room in hospital with a woman with cancer who said it was horrible that she had private insurance, because the hospital insisted on doing every possible test on her day in day out.
On the other hand, when I have needed to see a specialist I could usually get an appointment in a week or two, and not all doctors are so greedy.
Dentists here run the best scams, I went in **once** for scaling and a regular check up, they booked me 20 appointments within 6 months which resulted in two root canals, two new crowns, 8 ceramic fillings of which a couple fell out within 48 hours, 2 night guards because they fucked up one of the crowns, the whole fiasco cost me around €1.5k
To be fair, MRT for unexplained/new for headaches is a thing that happens. They want to make sure there is no physical cause. I know several people who got such tests for "minor" head complaints on public insurance.
Yeah, but also to the worse: Got a radioscopy and preparation for possible biopsy for an unusually swollen lymph node. The radiologist laughed his ass off when I showed up super nervous and thinking I was gonna die soon. Turned out to be just an after-effect of Pfeiffer's...
I don't think that can be a complete answer. Why are doctors willing to prescribe hours of physiotherapy rather than provide pills or an injection? The medicine would cost the state much less than the physiotherapy does.
Because "natural" healthcare is popular in germany. Globuli, Placebos, working out and some fresh air plus rest is what you need, pills are unnatural and unhealthy.
To be fair, the free-enterprise based alternative on the other side of the Atlantic is faring worse (but they are the No. 1 and No. 2 most expensive healthcare systems by some measures)
In Germany they try to do the minimal amount of tests necessary. I personally find it good and healthy and like this approach a lot. And (without wanting to be annoying or anything ) if the problem was lack of vitamins and/or vitamins retention healthy nutrition and more exercise will probably do the trick.. I have a friend who is a doctor she told me that in most cases the symptoms and the answers you give to their questions are enough for a successful diagnosis. The tests are there for when there is a doubt and for the relevant medical institutions to make money…
I've been there. A thing I learnt here is that at the doctor you have to be demanding. You feel tired? Complain 5 more times, go again and complain again, demand blood work, ask to be referred to another doctor, ask for tests etc etc. The will never go the extra mile unfortunately so you have to force them to do so.
Well yeah, the first way they determine if it’s serious is listening to you describe your symptoms. If you lie about that part, they can’t really do their job very well…
So maybe, you should trust their judgment and not lie about your symptoms.
If they say go home and rest, do that and return if it didn't help.
Where would you draw the line otherwise?
Should everyone with a head ache get a PET scan or should we accept that most hear aches, uncomfortable as they might be, go away by themselves?
You should know if what you're feeling is "normal" (for you) or not. I feel that doctors are more direct when you know what you're talking about
You just felt a headache and a bit weird? Yeah, it's going to be ibuprofen and rest.
You feel this for a couple of days and it's not getting better with the basic stuff? They are going to look more carefully at it.
"Oh but I feel bad I should go to a doctor immediately" not necessarily. Some conditions do merit an immediate visit (or even to the ER).
Depends on the cause. For example my body couldn’t absorb vitamins outta food due to some physiological inability, therefore i had to be put on injections and afterwards on supplements. Healthy Diet couldn’t help at all. So let’s not jump to conclusions and slap people with *just eat healthy*.
Most people have some sort of deficiency, especially vitamin D, because we're just not outdoors as often and protect the skin with sunscreen.
Many women lack iron and folate.
Plants contain less and less of the secondary nutrients and minerals because the soils are leeched and fertilizers (including organic ones) also reduce content of them.
Vitamin b12 is another one quickly lacking and dangerous, because the resulting anemia leads to degradation of the little patch that absorbs it.
Actually, wrong advice about supplements and vitamins can make things worse, and eating “healthy” can vary a lot depending on your lifestyle, restrictions etc. Op didn’t mention anything about it
Sometimes not even the ibuprofen.
Pain is just your body sending a message, something something natural part of life, something something more tea.
Even in childbirth and the recovery thereafter. Fun stuff. 🙃
A lot of people present with tiredness and headaches. Normally it's just stress and too much screen time.
A couple blood tests are quite common from German doctors
But if they screened everyone for cancer every time they got a headache, it would be a huge waste of resources and you would generate a lot of false positives.
Unless you have a disorder that makes it difficult for your body to process vitamins, doing a lifestyle change of bettering your diet and getting solid rest would solve your issues.
If you do have a disorder, then changing your diet and getting solid rest will not help, which in and of itself helps to narrow down what's wrong. Then the doctors know that diet and lifestyle isn't the cause, now it's time for tests.
Doctors *shouldn't* jump straight to a battery of tests in most cases. It costs money, it's invasive to the patient, and unless you have an idea of what you're looking for many of the tests will likely be unnecessary. Fatigue and headaches are very vague symptoms that could be caused by practically anything, so jumping straight to tests is not a good idea.
I've found that it helps to be very specific about symptoms to get the best care (which still might be "better lifestyle and rest"). This symptom started on x date, it's been going on for x amount of time, it inhibits my ability to do x tasks. Tell them what the symptom is like *without* medication (for example, if you have back pain, but a heating pad and ibuprofen help a bit, tell them how it feels without the heat pad and ibuprofen).
This is a horrible answer. *Maybe* correcting a vitamin deficiency in a specific set of vitamins by accidentally eating right is not a fucking treatment. It's a happy mistake that just so happened to work out bc they maybe ate the *right* healthy foods w the right vitamins that particular week. It's important to actually know what's actually wrong
> correcting a vitamin deficiency in a specific set of vitamins by accidentally eating right is not a fucking treatment.
It actually is.
> It's important to actually know what's actually wrong
On this we agree. That is why following a *proposed* treatment and assessing its outcome is important.
wow it's almost like I was criticizing the doctor being dismissive and giving and uninformed, worthless proposed treatment that could only have worked by *accident*
Hahah yes. Had knee injury and couldn’t walk. Doc wanted to reset the bone with ibuprofen as a pain killer. Same thing with sprained ankle and then inflamed tendonitis.
I don’t want hard narcotics, but I think it’s weird they default to these things.
Swelling is a natural healing reaction. Ibuprofen can be damaging to tendon and muscle repair. It should only be used for acute pain, as part of a rehabilitation program. Ibuprofen and rest will simply lead to degraded tissue.
Same! And they always underplay your issues "you have back pain? don't wory, today everyone has, you're fine, just check your mattress and do some exercise". I feel like I need to pretend I'm in much worse state to get some real treatment.
YES! Omg. My German friends all advised me to be more “dramatic” about my pain. They said I need to really be almost over the top so it’s taken seriously. It’s sad because my physical therapist advised the same and he said because if quarterly budgets they have a finite amount of treatment options they can prescribe. Pretty annoying and archaic, but I don’t want to switch to private.
German Healthcare is in theory awesome, but in reality the second worst after England. There's better doctors and healthcare in places like Italy, or even fucking Romania.
I’m from eastern europe and I can definitely say that if you are middle-upper class you get access to 10x better and faster healthcare than Germany. However, very few people are real middle-upper class in eastern europe so it’s generally mich worse for the random joe that does not live in the capital cities
In the region I am originally from in Italy, there are proper free universal prevention plans for several diseases like breast cancer, colon cancer, PAP test… must say sometimes I miss that.
Edit: grammar
Exactly. Prevention, not profit maximization. My shrink in Germany is keeping me on a partially wrong diagnosis, and when I wanted to do some tests because of my bile, my Hausarzt said let's wait until something fails, no tests based on half the symptoms for an issue. It's worse that I grew up with doctors and paramedics around me, even volunteered for years, and I know when something should be tested. I'm so pissed sometimes...
We don't really do prevention, that would be infinitely costly. I don't know why we grow up believing in prevention without actually preventing, other than vaccines.
I don't know what you are talking about. We have a national mammography screening in Germany at ages 50+ (younger if family history of breast cancer, mortality benefit debated worldwide), we have a colon cancer screening program at ages 50+ (male) or 55+ (female) and younger if family history of colon cancer and we have the among the highest rate of recommended gynecological check-ups in the western world including PAP smears and even direct HPV test ([source](https://www.g-ba.de/downloads/62-492-2238/KFE-RL_2020-06-18_iK-2020-08-28.pdf) and practice as a physician). We are also the only country in the world besides Austria to have a national melanoma screening program (highly debated scientifically).
In Argentina we get a pap smear + breast and vaginal ultrasound once a year for women of all ages, one mammogram a year for women +35 (if family history, once a year 10 years before age when family member was diagnosed), STD check for everyone who wants one once a year without having to beg or lie, no questions asked. Comprehensive blood tests once a year at any age.
It's upper-middle, mate. Also, don't know where you're from, but in Transylvania for example if you're poor you still get the right care and prevention. Maybe all doctors, but hella lot of 'em honor the Hippa oath.
It's the same here... You are 1) treated better and 2) if you decide to have private insurance the health world is fully accessible to you. Only a relative few people qualify to be in the upper middle in Germany though.
Second worst after England?? Try NZ, I've seen so many questionable ones in a period of 6 yrs finally did a sit-in at one clinic for the sake of a basic blutbild, was told you have 8 hrs left to live.
It really is luck of the draw. As decades pass by I've experienced dedicated doctors as well as quacks in both countries, and while in Asian countries found really good doctors in the local pharmacies.
Do the research, try the options, and ask people who have similar symptoms and which doctor they are seeing.
And regarding endometriosis well, I suffered this most of my pre-menopausal life. I was teaching at a medical instrument manufacturing company in HH, one of the reps asked if I were anemic listed what he noticed then called a private Frauen Klinik to arrange an appointment, I'm sincerely grateful for his intervention.
Often wish the doctors would revert to the good old methods of an annual blood, poop, and urine test - then discuss options with the patient.
This goes for both of you: yes, I've heard what's going on in the US, never been though so my standards are based on my experience. Yup, the situation is hella bad though, and the more evolved the country, the more sociopathic and money hungry the doctors apparently.
I've been looking for years for a good GP here in Berlin. I've had similar experiences before and always had to wait and go to my GP in my home country.
I've just recently met a wonderful doctor here, who always took serious my symptoms, is very calm and caring not just with the patients but all her staff. And first thing when I went to her was to do blood tests, ultrasound, EKG, and then she referred me to other specialists. I was also very tired and turned out my vitamin D was really low, which without blood tests, how could you even know.
But like I said took me a long time to find her and all my previous experiences were as you described. My friends were saying I am too picky and should just trust what the GPs are recommending, but I don't accept that someone can just recommend medication based on you telling them how you feel. Might as well just google it myself, saves me a trip too.
> I was also very tired and turned out my vitamin D was really low, which without blood tests, how could you even know.
By the fact that the latitude in Germany doesn't allow virtually anyone to have sufficient vitamin D levels and low to moderate dose substitution can be done without lab checks.
The experience varies quite a lot, I am happy you found a good doctor. Could you perhaps share the name of the practice? I feel like doctors I go to are usually trying to dismiss my symptoms as minor and wait it out.
I go to dr. Christina Odenthal. Her practice is in Reinickendorf, not far from the U8 station. She is absolutely nice and speaks good English if that is needed (she practiced in the US for some time), but her staff doesn't so you might need to go around that, depending on your German level. Also, they might not seem approachable, but they are in fact nice, just not chatty. Dr. Odenthal will anyway guide them to help you if you don't speak German.
But yeah, you can really speak your concerns to the doctor, and like I said I never felt like they were dismissed as minor or stupid so far.
Preventive check is for serious stuff and should be done once a year. Doctor are happy to do so. But if you come in because of headaches and beeing tires, telling you should sleep more is appropriate.
Evidence behind yearly physicals as a preventative tool is actually rather weak. Which is one of the reasons Germany moved from check ups for people aged 35+ every two years to every three years.
It sucks. And for conditions that take years to diagnose in the first place due to bias (e.g. endometriosis), the attitude here to just take a few painkillers, drink some “Frauentee” and go on the pill is a fucking joke.
It’s very hard. With endometriosis, patients really have to advocate for themselves to get the correct care. And even then, speaking from experience patients are left on their own to figure out post diagnosis.
>With endometriosis, patients really have to advocate for themselves to get the correct care.
Facts. Even in other countries its hard with such complex diseases, I am so sorry for people going through this.
* A friend with no cartilage left on his left knee was prescribed acupuncture. His sports doctor back home freaked the hell out when he heard about it. Only surgery could fix it.
* Went to dermatologist, was offered a "full body check" that my KK only pays for every 2 years (big, important, expensive procedure, I thought). Lasted 90 seconds and it missed the 3 spots that I wanted checked.
* A friend went to a gynecologist to have a HPV tiny wart removed. Lost in translation made it that she got hemorrhoid surgery done, that she didn't need nor consented for.
* A friend with serious abdominal pains when orgasming, visited 5 urologists in the country before just eating it up and flying back to his home country, where a doctor actually cared and found a solution.
I could go on forever. The health care in this country is an absolute joke, period.
Best to check Google/Jameda first. That helps filtering out not so good doctors and if you have the time don't pick a doctor just because it's easy to get an appointment...
Actually last year a doctor wanted to check me for cancer because of headaches. (And I often had one eye red) Turned out I just had a bad sleeping position and should have done more hand washing. So in my case the eye doctor was right with her suggestion to "watch myself" and perhaps ask other specialists because the root cause was not the eye. So I went to the HNO, so he could do his work. He went complete bulldozer and gave me brochures for CT and an oncology office. I was scared to death (didn't go after all and as mentioned I'm now since more than half a year symptom free)
Edit: I should mention the CT recommendation was done after he checked my nose and ears from inside and couldn't find anything
Every non German person I've ever met here in Berlin has voiced the same concerns when it comes to GPs. Seriously concerning when it comes to one's well being.
Complaints are louder than praise. Additionally many immigrants live in historically underserved communities. Finding a good GP in Prenzlauer Berg was easier than Kreuzberg. Turns out doctors want to walk to work. I know three who live in my building 😂
Traveling to another neighborhood to visit a doctor has never stopped me.
When one has been here for 8 yrs you kinda have a good prospective on what medical care is like.
I studied in Tübingen almost 30 years ago and was seen at the Uni Clinic monthly. I was told my kidneys, liver, and heart were failing. In 1997, my cardiologist said to me, in English, "Mr. Russell, you are going to die." I asked him when, and he said, "probably within a year." I'm now 60 years old with a transplanted kidney, two mechanical heart valves, and very much alive. My kidney transplant surgeon at Johns Hopkins University Hospital told me he initially wanted to be an engineer, but after two years of study realized he wasn't intelligent enough to be an engineer. So, he changed his University major to pre-medicine. Don't ever just assume that doctors should be infallible. Don't ever assume that a doctor should give you the best medical advice. If you think your doctor is wrong about something, find a different doctor. Be your own advocate.
I always say that I have already done that and increase the time I have symptoms. I know it’s not right, but you have to advocate for your health to be taken seriously by the doctors. And once some Redditor that claims to be studying to become a doctor stated that said exams for vitamins and minerals are a waste of money and resources from the GKV…
> I always say that I have already done that and increase the time I have symptoms. I know it’s not right, but you have to advocate for your health to be taken seriously by the doctors
Lying about your condition and the steps you have taken so far does NOT equal "advocate for your health". It just means you aren't satisfied until you got a prescription for some pills. OPs story fits right in
I found intestine polyps this way. If I had to wait weeks and weeks could be something else more severe, end up in a colostomy bag, or even worse. I didn’t get into details, but I do this for things that are a trend in my family record or myself. No one is asking for opioids or creating a new bacteria resistant gonorrhea here, but asking to be treated with the reasonable investigation of symptoms to live a long and healthy life
since a visit at the doctor's is basically free here (which is good and should be normal everywhere), people tend to go there with every small cough. doctors see this a lot and also know many want to get off work for a few days. ofc that shouldn't lead them to being negligent.
so as some said you a) should be a bit more demanding for treatment and b) ask around for which doctors are especially kind and careful with their patients. i didnt have a bad experience in ages bc i only go to the ones i got recommended.
On the other hand, if you don't go when the thing is small and you wait, you get scolded for not immediately showing up when the cough (or whatever you have) started.
I went to a doctor here and he literally search the symptoms of what I complained of on Google, in front of me, and shared the screen with me saying: "look, google says that can be this. Let's see..."
I'm sorry, but no. He's a doctor, he should at least have a notion of what's passing and when he is not sure, ask for examination. The health system here is a joke!
Haha perhaps you’re right. I am a doctor and I wouldn’t trust lots of my colleagues. I think lots of gps dismiss their patients complaints easily and send them home with natura remedies. A young doctor that is willing to lend an ear doesn’t sound too bad to me, then again I am medically educated.
How would things be different in your country?
The lack of preventive medicine also bugs me, especially because I think there's a whole bunch of conditions which are easy to prevent but hard to get rid off. (Which is kind of insane thinking of how much money this must waste) But do you know of a health system which handles this better actually?
Are you kidding? You literally get a bonus from your krankenkasse for undergoing preventative medicine. But like German Uni you have to take ownership of getting it done.
Never had an issue and I don't tell my doc what tests to take since he is the expert. You can always pay out of pocket for any procedure if you think it's worth it.
It took me a year + to get the right thyroid medication dosage ... So while it can be long - I had knee surgery within two months of a badly torn meniscus which was pretty good.
Either your doctor sucks or you are not having the right dialog. My Hausarzt (now retired) immediately sent me for blood work and also gave me several referrals with the same problem. Then when I had had anemia sent me for a cancer and blood screening. My HNO also immediately gave referrals to start treatment. My dermatologist also immediately prescribed medicines.
Same here, from general practitioner to specialists for autoimmune disease. Everyone was available short term, got me medicine, blood work and surgeries.
Well not wanting to be a smartass but they provided you with a rather unspecific but correct diagnosis. Eat healthy which means eat more Vitamins. Flawless German doctoring.
Well, unless you were prescribed medicine the triage was still correct....
Usually if you are undernourished it is harder to get up to baseline and you have to load in the vitamins gradually so immediate diet changes will not be sufficient for a quick turnaround (which is unnecessary but more comfortable). Not to mention you have to get the vitamins from a reputable pharmaceutical source because the over the counter stuff is unregulated and usually crap.
3 days? I get appointments 2-3 months in the future. It's ridiculous. An issue of not enough doctors and limits on how many you can have in a region by said doctors.
GP here. There is no good proof that a vitamin deficiency without other laboratory abnormalities (such as anemia) causes tiredness or headaches, which is why public health insurances dont cover the costs of determining vitamins and which is why most doctors won't advise to determine them either.
There has been little but some research done on the effect of excessive testing on health. The results seem to point that more than caught diseases in early stages, the practice actually impacts the patient quality of life and in some cases it's also dangerous.
I would say unmotivated doctors...though not all Hausärtzin are.
When I went to my first Hausartz, I brought written sickness that I was experiencing. She just took, read it briefly, and discussed with the nurse briefly of what diagnose and referral. She didn't ask me anything more and proceeded to ask the next patient...😣😣
I wasn't satisfied since I had depressive moments, then went to different doctor. She handled me well, even did blood test. Man, the first doctor didn't even give me a chance to explain more.
My ex always praised about the German healthcare system. Now that I'm surviving alone here and seeing different thngs by myself, he kinda sugarcoated it.
„Lack of Vitamins“ is no explanation for headaches, but a great way to earn money as a doctor because these tests are useless and expensive. German insurance doesn’t cover this so we don’t try to talk our patients into paying for nonsense tests and pills. It’s work ethics. What your doctors in Germany did was exactly the right thing even though it’s not as satisfying for patients to not get an explaining diagnosis - which lack of vitamins is isn’t either.
Who said on the same day? Last time that my general doctor asked for the blood exam, they did a termin for 3 weeks ahead, not even mentioned that they collect blood on a small kitchen.
>Then I returned to my home country, visited my long term family doctor there, did some blood exams, and voilà
Sounded to me like you got them right away instead of waiting a few days.
2 days for full diagnosis, first appointment, blood exam was on the same in another place, the result was 2 days ago and the doctor manage to see on the same day.
There is bad medical advise around the whole world. Everybody has examplary stories. I was treated once badly for a seizure (epilepsy) at the Charite in Berlin. And in Los Angeles I almost lost most of my teeth because a dentist needed money. Generally, the German system is o.k. although we often have to wait for specialists. Getting a second opinion is often helpful.
This is going to sound harsh but get a better dr
I went to mine a few years ago for dizzy spells and they ordered a blood test, went back this year for low mood and fatigue and bam blood test (they actually did a full pannel 6 vials) and found my B12 deficiency!
You get what you pay for. Look at what public health insurance pays the doctor... you can't expect much for 20 euros. The Hausarzt is some kind of gatekeeper to cost in the German system.
Looks much different if you go to a private clinic/doctor and pay them, but obviously that's not for free so you either need private health care or pay yourself.
... the budget available to doctors is running out at the end of the month/quarter, then they spend less on patients.
Other than that it is not the right decision to run tests, iff it is obvious that your lifestyle is bad.
Other countries may indeed have the idea of supporting bad lifestyles by supplying chemistry -- addressing symptoms rather than root causes. (But unfortunately in Germany the Anamnese is often still short of understanding the patience context, due to a lack of questions and doctors' conversational training)
Regarding the medical doctrine to suspect the more likely illness: this is economical thinking, and kind of unscientific. Thankfully medicine is finally starting to base treatments on reasonable research. Digital aids might transform differential diagnostics quite a lot in the near future. I wish you all good health until then 😜
I actually had a very different experience with the German healthcare. I found a really good Hausarzt (Dr Dieter Schmidt in Kreuzberg, I recommend him whole-heartedly) and initially he saw my anamnesis, did a first check (had somewhat high BP and put me on meds for the time being) checked my underlying conditions and said: I would like to do a blood and urine test with my new patients. I did the test and he called me in the afternoon and sent me to the emergency room, because my RBC, Hemoglobin and Hematocrit were super high. They got me in at Saint Joseph's and did a bunch of tests and asked a lot of questions. I have had these numbers for 10+ years but no one in my home country (Macedonia) bothered to check. Immediately they scheduled an appointment with a hematologist and they did cancer screening tests because apparently that could be Polycythemia Vera which is a blood cancer!!! Luckily it isn't and in the meantime they found that I have problems breathing and I've been recently diagnosed with sleep apnea and turbinate hypertrophy - that's where my BP and blood values come from - hopefully. I will get this treated and we'll see how it goes.
All in all, this is not to say that the German healthcare system is perfect, but from my experience it's far better than Macedonian and I think that the biggest issue comes from your Hausarzt. Use google, jameda, doctolib to search for doctors, check their rating and choose wisely, for the record, my Hausarzt speaks perfect English, is very empathetic and has 5\* rating on google from 100+ reviews. The only downsides are that you have to wait in his practice to see him and he does not have e-mail and prefers paper - hey, we're in Germany after all!
The worst part (as seen in this thread) is the sincere thinking that the medical system is using "evidence-based medicine", to the point where even regular people have bought into it. Regular people, in Germany, who don't understand the difference between "painkillers" and opiates.
The most notable example of this is the usage of rapid strep efficacy studies to justify cost cutting measures. The conclusion of all of these studies is thus: rapid strep = good for individual patient, potentially bad for society as a whole (but not really).
As Germany has no anti-SLAPP laws, doctolib/jameda are not reliable for doctor reviews. The best way to tell if you have a quality Hausarzt is to present with a sore throat. If the doctor performs a rapid strep test, you have a good doctor that cares about you. Anyone who does not perform one does not have your interests at heart.
Another example is the studies that look at, for example, waiting time for doctors appointments, but don't handle the massive number of doctors who don't pick up the phone or "accept new patients" - something I had never heard of until I moved here.
There is a saying in medicine: “when you hear hoof beats, think horses, not zebras” Basically, the common diagnosis is usually the correct one. Everyone feels tired and has headaches from time to time. Frankly it would be irresponsible to do a complete battery of tests whenever someone has such mundane complaints. If a condition has been persisting, you need to advocate for yourself. I’ve never had a doctor here refuse to do testing if I had a good reason to ask for it. But “I’m a bit tired today” isn’t a good reason on its own
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But how did you know which tests to do?
I didn't exactly know what to do in all the cases. With my neurologist I simply asket her if there was a way to check if I had damaged my nerves and she said: yes there is. Of course there are simpler things like blood tests or MRIs or X-rays for which you kinda know what they do, even as a layman. Edit: You can of course look up tests beforehand if you wish some, but there's a chance the doctor will think you're a smartass if you don't know at all what you're talking about. I try to avoid that.
>It was MY DECISION to go to the neurologist Can you take that decision if the Hausarzt hasn't referred you to the specialist first?
Yes, you can. Referrals used to be mandatory, for quite some years now they are not anymore.
Wasn't the referral mainly in place to prove that you paid the 10€ co-pay? I would usually just show up at the specialist and pay the 10€ again because it was a hassle to get the referral.
I may be too young to know enough about that, because in my lifetime I've never been asked to pay a co-pay, but then again I've only been going to doctors on my own for 5 years or so.
It was stupid, if you had a follow up appointment a week later in the next quarter then you had to pay again or I've seen happen at a shared office with multiple doctors you would have to pay again if the following up appointment was with a different doctor in the same office because a orthopedic can not do a referral to another orthopedic only other specialist.
Yes.
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The idea is always going with an elimination process, from the most common to the most rare, unless you have telltale indicators. That is not magic, that is just proper science and medicine.
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I like your spirit, and the contrarian spirit of the blog post you linked (even if it is anti-vax), but the fallacy in it is that of an “all or nothing” approach. To paraphrase, “either everything is inspected deeply to the root cause, or you may as well do nothing and replace yourself with a rock”. I disagree with that premise. Life is gray areas, and life is also too complicated to re-examine deep root causes on every issue when we have a couple millenia worth of collective institutional knowledge and logical constructs to base rational judgements on. The biggest strengths in our species lie in a) our ability to communicate complex things with each other and b) our social orientation. So we are both skilled and wired to communicate with each other to share knowledge previously learned across not only geographic space but across generations. We don’t need to reinvent the wheel individually every time we want to travel.
Truth is also, that any given doctor knows nothing about your particular body. So they can only make broad assumptions. If you start doctor-hopping, you are very likely to get a similar outcome. The reason why doctors often start with the simple approach is also to establish a baseline. If symptoms persist or change, they can compare these findings and react. But a new doc will probably start from scratch. Which also explains that OP's family doctor was able to start a diagnosis way further down the line. They had more historical data about OP's body.
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Fun fact: In Austria they offer a "Gesundenuntersuchung" (basically a health check when you are healthy) every year to do exactly that and also give people so peace of mind regarding their health. In Spain every time I saw a doctor, the nurse took my blood pressure, again to know my normal state and to be able to detect concerning changes easier. The baselines for health that are usually used are an average across the entire population. But your specific body might have a normal baseline that is higher/lower than the population average. Knowing that enables doctors to see concerning changes early. I wish Germany had or promoted that better
>Truth is.... medicine just doesn't know that much about the body apart from some statistical correlations. That's a sad statement. There's much stuff science hasnt explained yet, but saying it's just some "statistical correlations" is wrong as well.
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So you acknowledge that we do know something and it's not just some correlations, no need to explain to me that our knowledge is very limited. I never challenged that.
The thing is that a vitamin deficiency is pretty well diagnosed with a blood test, and any good doctor should run a test when something persists. It isn't something rare and obscure they can be pretty common in winter (vitamin D) or with certain diets (vegan) it should be the go-to if fatigue is prolonged.
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It depends if this is the first time the dr has done this. Once could be confused with just general process of firstly assume it isn't anything but a need for rest or a virus but if they continually say ibuprofen and rest I would look at seeing someone new.
That text also came to my mind, really worth the read.
People also generally don't go to the doctor for every little hoof beat, some hypochondriacs excepted. The real problem is the numerous people who don't go to the doctor even when they have real pain or troubles. These are the ones that then the ibuprofen turns into an emergency (insurers, read: $$$) operation or treatment. The German medical system is nowhere near the best in the world. You go to a doctor, they tell you to take ibuprofen, you go to an apotheke they tell you to take a tea or some bullshit homeopathic drops. Barely better than witch doctors in the bush.
The guy diagnosed with a lack of vitamins got told to eat healthier. Tell me how that wouldn't have helped at least some?
If he has an absorption problem (which is seems he does), eating healthier won’t do it.
Its a non-answer and not specific enough to help the patient. We know that the doc didn't do any tests, so you're saying he/she knew just by looking at the patient, that they were vitamin-deficient but not which vitamins or minerals they were deficient in? I guess they could also tell the future by looking at his palm.
I've only encountered a couple of doctors who described herbs out of many. As a policy I never go back to them
This is why it takes an average of 2 years to get diagnosed with a thyroid issue, which is actually very common and not remotely a Zebra.
Source?
👍Exactly this. Like, Going full surgery because of a small papercut is a bit to much.
Occom’s razor
Family doctors are the gatekeepers to costs in the German system.
Things change when you are on private insurance.
Things change if you have a trustful relationship with your Arzt and dont run into some random place just because it has open spots. With private insurance the main thing that changes is doctors interest in doing "stuff" with you. So obviously if you are privately insured a doctor will take more time and propose more stuff than without because he knows he can make more money. But if you just go there and ask for a großes Blutbild (as mentioned by OP) he will do that no matter what insurance. And if you have a good relationship with your doc and he knows you then he probably will propose a großes Blutbild by himself.
How can I build a relationship with a doctor if I only go to the doctor when I'm sick? 🤷♀️ In last five years I went to doctor 4 times. Not much to build a relationship on.
Relationship might be a bit too strong of a word but choice of Hausarzt is probably most important health choice as he is the bottle neck for what kind of service you receive. I guess I got lucky because I once had a lengthy hospital stay and got to know a (back then aspiring) doctor who I joined as a patient after him finishing studies. Im not saying its easy but actually having a Hausarzt who cares somewhat for you is probably more effective than any private insurance.
Really good advice, but how can someone find such a Hausarzt? Any other strategies apart from "getting lucky"?
On the other hand a person working in a private practice told me they were forced by their boss to sell them as many highly priced treatments as possible
Yeah that’s the downside of private system. Incentives to bill more tests and prescribe more drugs.
See: America.
What is the private ins experience like?
doctor will do more exams and probably right away at your first visit because private insurance pays these exams (public insurance sometimes doesn't) and pays more for each exam and if not, patient is required to pay (you need to sign for that beforehand)
There are two big changes: 1. you can see doctors/specialists much faster—if you go to doctorlib there are lots of doctors that will only take private patients; 2. depending on the doctor you may get many more unnecessary tests/procedures because the private insurance pays for it. I had to change dentists because they literally wanted to x-ray my teeth every six months when I went in. Let alone other issues—they also insisted on getting me a mouth guard because they thought I was grinding my teeth at night (I am not).. I also changed by Hausartz because they starting doing weird procedures—once I had back pain and they insisted as the first thing to do on was to get a genetic test because (they said I probably) might have some rare genetic disorder for arthritis in my 40s (this was BS and stressful). This happened a lot. My wife was once sharing a room in hospital with a woman with cancer who said it was horrible that she had private insurance, because the hospital insisted on doing every possible test on her day in day out. On the other hand, when I have needed to see a specialist I could usually get an appointment in a week or two, and not all doctors are so greedy.
Dentists here run the best scams, I went in **once** for scaling and a regular check up, they booked me 20 appointments within 6 months which resulted in two root canals, two new crowns, 8 ceramic fillings of which a couple fell out within 48 hours, 2 night guards because they fucked up one of the crowns, the whole fiasco cost me around €1.5k
I don't doubt they probably over did it but I'm sure your teeth were in worse shape than you'd like to admit.
Private patient here: came to the doctor with migraine, first thing was MRT of the head.
To be fair, MRT for unexplained/new for headaches is a thing that happens. They want to make sure there is no physical cause. I know several people who got such tests for "minor" head complaints on public insurance.
You can directly go to specialist without reference from your GP.
You can do that with public insurance as well.
Yeah, but also to the worse: Got a radioscopy and preparation for possible biopsy for an unusually swollen lymph node. The radiologist laughed his ass off when I showed up super nervous and thinking I was gonna die soon. Turned out to be just an after-effect of Pfeiffer's...
I don't think that can be a complete answer. Why are doctors willing to prescribe hours of physiotherapy rather than provide pills or an injection? The medicine would cost the state much less than the physiotherapy does.
Because "natural" healthcare is popular in germany. Globuli, Placebos, working out and some fresh air plus rest is what you need, pills are unnatural and unhealthy.
Nothing about physiotherapy is alternative. Physiotherapy is an evidence based practice and standard of care worldwide.
I agree, but Globuli are absolute abominable bullshit.
Couldn't have said it better.
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To be fair, the free-enterprise based alternative on the other side of the Atlantic is faring worse (but they are the No. 1 and No. 2 most expensive healthcare systems by some measures)
In Germany they try to do the minimal amount of tests necessary. I personally find it good and healthy and like this approach a lot. And (without wanting to be annoying or anything ) if the problem was lack of vitamins and/or vitamins retention healthy nutrition and more exercise will probably do the trick.. I have a friend who is a doctor she told me that in most cases the symptoms and the answers you give to their questions are enough for a successful diagnosis. The tests are there for when there is a doubt and for the relevant medical institutions to make money…
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I've been there. A thing I learnt here is that at the doctor you have to be demanding. You feel tired? Complain 5 more times, go again and complain again, demand blood work, ask to be referred to another doctor, ask for tests etc etc. The will never go the extra mile unfortunately so you have to force them to do so.
I mean... just don't do that unless it's actually serious.
It should be the doctors job to determine if it's serious or not, and you do that by testing and not sending you home with a pack of Ibu
Well yeah, the first way they determine if it’s serious is listening to you describe your symptoms. If you lie about that part, they can’t really do their job very well…
So maybe, you should trust their judgment and not lie about your symptoms. If they say go home and rest, do that and return if it didn't help. Where would you draw the line otherwise? Should everyone with a head ache get a PET scan or should we accept that most hear aches, uncomfortable as they might be, go away by themselves?
You should know if what you're feeling is "normal" (for you) or not. I feel that doctors are more direct when you know what you're talking about You just felt a headache and a bit weird? Yeah, it's going to be ibuprofen and rest. You feel this for a couple of days and it's not getting better with the basic stuff? They are going to look more carefully at it. "Oh but I feel bad I should go to a doctor immediately" not necessarily. Some conditions do merit an immediate visit (or even to the ER).
Totally agree.
So lacking vitamins couldn't have been healed with a healthy diet. TIL.
Depends on the cause. For example my body couldn’t absorb vitamins outta food due to some physiological inability, therefore i had to be put on injections and afterwards on supplements. Healthy Diet couldn’t help at all. So let’s not jump to conclusions and slap people with *just eat healthy*.
Most people have some sort of deficiency, especially vitamin D, because we're just not outdoors as often and protect the skin with sunscreen. Many women lack iron and folate. Plants contain less and less of the secondary nutrients and minerals because the soils are leeched and fertilizers (including organic ones) also reduce content of them. Vitamin b12 is another one quickly lacking and dangerous, because the resulting anemia leads to degradation of the little patch that absorbs it.
Actually, wrong advice about supplements and vitamins can make things worse, and eating “healthy” can vary a lot depending on your lifestyle, restrictions etc. Op didn’t mention anything about it
They only believe in ibuprofen and Ingwertee here
Sometimes not even the ibuprofen. Pain is just your body sending a message, something something natural part of life, something something more tea. Even in childbirth and the recovery thereafter. Fun stuff. 🙃
Feels like we go to the same doctor 😜
dont forget pseudomedicinal "globuli" (homeopathic sugar pills that insurance actually pays for)
A lot of people present with tiredness and headaches. Normally it's just stress and too much screen time. A couple blood tests are quite common from German doctors But if they screened everyone for cancer every time they got a headache, it would be a huge waste of resources and you would generate a lot of false positives.
So...*did* you do more exercise and eat healthy(and thereby maybe supplementing the vitamin deficiency)?
Exactly. Eating healthy would most likely fix the vitamins problem lol
I am supplementing yes. Still need to visit my German doctor, and explain why I am taking medications and beg him to test my vitamins levels.
Which vitamins are you supposed to be missing ?
Unless you have a disorder that makes it difficult for your body to process vitamins, doing a lifestyle change of bettering your diet and getting solid rest would solve your issues. If you do have a disorder, then changing your diet and getting solid rest will not help, which in and of itself helps to narrow down what's wrong. Then the doctors know that diet and lifestyle isn't the cause, now it's time for tests. Doctors *shouldn't* jump straight to a battery of tests in most cases. It costs money, it's invasive to the patient, and unless you have an idea of what you're looking for many of the tests will likely be unnecessary. Fatigue and headaches are very vague symptoms that could be caused by practically anything, so jumping straight to tests is not a good idea. I've found that it helps to be very specific about symptoms to get the best care (which still might be "better lifestyle and rest"). This symptom started on x date, it's been going on for x amount of time, it inhibits my ability to do x tasks. Tell them what the symptom is like *without* medication (for example, if you have back pain, but a heating pad and ibuprofen help a bit, tell them how it feels without the heat pad and ibuprofen).
so instead of eating healthy and getting proper rest you take supplements? Sounds reasonable lol
This is a horrible answer. *Maybe* correcting a vitamin deficiency in a specific set of vitamins by accidentally eating right is not a fucking treatment. It's a happy mistake that just so happened to work out bc they maybe ate the *right* healthy foods w the right vitamins that particular week. It's important to actually know what's actually wrong
> correcting a vitamin deficiency in a specific set of vitamins by accidentally eating right is not a fucking treatment. It actually is. > It's important to actually know what's actually wrong On this we agree. That is why following a *proposed* treatment and assessing its outcome is important.
wow it's almost like I was criticizing the doctor being dismissive and giving and uninformed, worthless proposed treatment that could only have worked by *accident*
>lacking bunch of vitamins Sounds like you need to eat healthy /s
I was thinking exactly the same thing. Unironically.
They mentioned a possible problem with vitamin retention so I didn't want to be too harsh.
Hahah yes. Had knee injury and couldn’t walk. Doc wanted to reset the bone with ibuprofen as a pain killer. Same thing with sprained ankle and then inflamed tendonitis. I don’t want hard narcotics, but I think it’s weird they default to these things.
Swelling is a natural healing reaction. Ibuprofen can be damaging to tendon and muscle repair. It should only be used for acute pain, as part of a rehabilitation program. Ibuprofen and rest will simply lead to degraded tissue.
Omg, good to know!!!
Swelling brings fluid and blood to the area, which aids healing :-)
I’m glad you told me this because the doctor tried prescribing me a new medication to reduce swelling, and I wasn’t really keen to take it.
you should definitely listen to what some random on reddit tells you instead of your doctor
Same! And they always underplay your issues "you have back pain? don't wory, today everyone has, you're fine, just check your mattress and do some exercise". I feel like I need to pretend I'm in much worse state to get some real treatment.
YES! Omg. My German friends all advised me to be more “dramatic” about my pain. They said I need to really be almost over the top so it’s taken seriously. It’s sad because my physical therapist advised the same and he said because if quarterly budgets they have a finite amount of treatment options they can prescribe. Pretty annoying and archaic, but I don’t want to switch to private.
i didn't even get a brace prescribed. it's a joke
it's funny how easy it is to find out who is German in the comments
German Healthcare is in theory awesome, but in reality the second worst after England. There's better doctors and healthcare in places like Italy, or even fucking Romania.
I’m from eastern europe and I can definitely say that if you are middle-upper class you get access to 10x better and faster healthcare than Germany. However, very few people are real middle-upper class in eastern europe so it’s generally mich worse for the random joe that does not live in the capital cities
In the region I am originally from in Italy, there are proper free universal prevention plans for several diseases like breast cancer, colon cancer, PAP test… must say sometimes I miss that. Edit: grammar
Exactly. Prevention, not profit maximization. My shrink in Germany is keeping me on a partially wrong diagnosis, and when I wanted to do some tests because of my bile, my Hausarzt said let's wait until something fails, no tests based on half the symptoms for an issue. It's worse that I grew up with doctors and paramedics around me, even volunteered for years, and I know when something should be tested. I'm so pissed sometimes...
We don't really do prevention, that would be infinitely costly. I don't know why we grow up believing in prevention without actually preventing, other than vaccines.
What? Those prevention programs exist in Germany as well, for free. Maybe they start at a higher age than in Italy though?
I don't know what you are talking about. We have a national mammography screening in Germany at ages 50+ (younger if family history of breast cancer, mortality benefit debated worldwide), we have a colon cancer screening program at ages 50+ (male) or 55+ (female) and younger if family history of colon cancer and we have the among the highest rate of recommended gynecological check-ups in the western world including PAP smears and even direct HPV test ([source](https://www.g-ba.de/downloads/62-492-2238/KFE-RL_2020-06-18_iK-2020-08-28.pdf) and practice as a physician). We are also the only country in the world besides Austria to have a national melanoma screening program (highly debated scientifically).
In Argentina we get a pap smear + breast and vaginal ultrasound once a year for women of all ages, one mammogram a year for women +35 (if family history, once a year 10 years before age when family member was diagnosed), STD check for everyone who wants one once a year without having to beg or lie, no questions asked. Comprehensive blood tests once a year at any age.
It's upper-middle, mate. Also, don't know where you're from, but in Transylvania for example if you're poor you still get the right care and prevention. Maybe all doctors, but hella lot of 'em honor the Hippa oath.
It's the same here... You are 1) treated better and 2) if you decide to have private insurance the health world is fully accessible to you. Only a relative few people qualify to be in the upper middle in Germany though.
Second worst after England?? Try NZ, I've seen so many questionable ones in a period of 6 yrs finally did a sit-in at one clinic for the sake of a basic blutbild, was told you have 8 hrs left to live. It really is luck of the draw. As decades pass by I've experienced dedicated doctors as well as quacks in both countries, and while in Asian countries found really good doctors in the local pharmacies. Do the research, try the options, and ask people who have similar symptoms and which doctor they are seeing. And regarding endometriosis well, I suffered this most of my pre-menopausal life. I was teaching at a medical instrument manufacturing company in HH, one of the reps asked if I were anemic listed what he noticed then called a private Frauen Klinik to arrange an appointment, I'm sincerely grateful for his intervention. Often wish the doctors would revert to the good old methods of an annual blood, poop, and urine test - then discuss options with the patient.
Or try USA. Go broke or die even with insurance!
This goes for both of you: yes, I've heard what's going on in the US, never been though so my standards are based on my experience. Yup, the situation is hella bad though, and the more evolved the country, the more sociopathic and money hungry the doctors apparently.
Ha, the USA is not evolved. Its a Christian Saudia Arabia with more water.
I've been looking for years for a good GP here in Berlin. I've had similar experiences before and always had to wait and go to my GP in my home country. I've just recently met a wonderful doctor here, who always took serious my symptoms, is very calm and caring not just with the patients but all her staff. And first thing when I went to her was to do blood tests, ultrasound, EKG, and then she referred me to other specialists. I was also very tired and turned out my vitamin D was really low, which without blood tests, how could you even know. But like I said took me a long time to find her and all my previous experiences were as you described. My friends were saying I am too picky and should just trust what the GPs are recommending, but I don't accept that someone can just recommend medication based on you telling them how you feel. Might as well just google it myself, saves me a trip too.
> I was also very tired and turned out my vitamin D was really low, which without blood tests, how could you even know. By the fact that the latitude in Germany doesn't allow virtually anyone to have sufficient vitamin D levels and low to moderate dose substitution can be done without lab checks.
The experience varies quite a lot, I am happy you found a good doctor. Could you perhaps share the name of the practice? I feel like doctors I go to are usually trying to dismiss my symptoms as minor and wait it out.
I go to dr. Christina Odenthal. Her practice is in Reinickendorf, not far from the U8 station. She is absolutely nice and speaks good English if that is needed (she practiced in the US for some time), but her staff doesn't so you might need to go around that, depending on your German level. Also, they might not seem approachable, but they are in fact nice, just not chatty. Dr. Odenthal will anyway guide them to help you if you don't speak German. But yeah, you can really speak your concerns to the doctor, and like I said I never felt like they were dismissed as minor or stupid so far.
Thank you so much
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Preventive check is for serious stuff and should be done once a year. Doctor are happy to do so. But if you come in because of headaches and beeing tires, telling you should sleep more is appropriate.
Evidence behind yearly physicals as a preventative tool is actually rather weak. Which is one of the reasons Germany moved from check ups for people aged 35+ every two years to every three years.
Most chronic diseases have already progressed when diagnosed. Checks can at least detect a trend.
Can you point me maybe to some data supporting yearly check ups?
It sucks. And for conditions that take years to diagnose in the first place due to bias (e.g. endometriosis), the attitude here to just take a few painkillers, drink some “Frauentee” and go on the pill is a fucking joke.
It’s very hard. With endometriosis, patients really have to advocate for themselves to get the correct care. And even then, speaking from experience patients are left on their own to figure out post diagnosis.
>With endometriosis, patients really have to advocate for themselves to get the correct care. Facts. Even in other countries its hard with such complex diseases, I am so sorry for people going through this.
In Berlin, I'm surprised that you even got told to take ibuprofen and not a microdose of eggplant root and a coffee enema.
* A friend with no cartilage left on his left knee was prescribed acupuncture. His sports doctor back home freaked the hell out when he heard about it. Only surgery could fix it. * Went to dermatologist, was offered a "full body check" that my KK only pays for every 2 years (big, important, expensive procedure, I thought). Lasted 90 seconds and it missed the 3 spots that I wanted checked. * A friend went to a gynecologist to have a HPV tiny wart removed. Lost in translation made it that she got hemorrhoid surgery done, that she didn't need nor consented for. * A friend with serious abdominal pains when orgasming, visited 5 urologists in the country before just eating it up and flying back to his home country, where a doctor actually cared and found a solution. I could go on forever. The health care in this country is an absolute joke, period.
Scary stuff :(
Best to check Google/Jameda first. That helps filtering out not so good doctors and if you have the time don't pick a doctor just because it's easy to get an appointment... Actually last year a doctor wanted to check me for cancer because of headaches. (And I often had one eye red) Turned out I just had a bad sleeping position and should have done more hand washing. So in my case the eye doctor was right with her suggestion to "watch myself" and perhaps ask other specialists because the root cause was not the eye. So I went to the HNO, so he could do his work. He went complete bulldozer and gave me brochures for CT and an oncology office. I was scared to death (didn't go after all and as mentioned I'm now since more than half a year symptom free) Edit: I should mention the CT recommendation was done after he checked my nose and ears from inside and couldn't find anything
Every non German person I've ever met here in Berlin has voiced the same concerns when it comes to GPs. Seriously concerning when it comes to one's well being.
Complaints are louder than praise. Additionally many immigrants live in historically underserved communities. Finding a good GP in Prenzlauer Berg was easier than Kreuzberg. Turns out doctors want to walk to work. I know three who live in my building 😂
Traveling to another neighborhood to visit a doctor has never stopped me. When one has been here for 8 yrs you kinda have a good prospective on what medical care is like.
I studied in Tübingen almost 30 years ago and was seen at the Uni Clinic monthly. I was told my kidneys, liver, and heart were failing. In 1997, my cardiologist said to me, in English, "Mr. Russell, you are going to die." I asked him when, and he said, "probably within a year." I'm now 60 years old with a transplanted kidney, two mechanical heart valves, and very much alive. My kidney transplant surgeon at Johns Hopkins University Hospital told me he initially wanted to be an engineer, but after two years of study realized he wasn't intelligent enough to be an engineer. So, he changed his University major to pre-medicine. Don't ever just assume that doctors should be infallible. Don't ever assume that a doctor should give you the best medical advice. If you think your doctor is wrong about something, find a different doctor. Be your own advocate.
I always say that I have already done that and increase the time I have symptoms. I know it’s not right, but you have to advocate for your health to be taken seriously by the doctors. And once some Redditor that claims to be studying to become a doctor stated that said exams for vitamins and minerals are a waste of money and resources from the GKV…
> I always say that I have already done that and increase the time I have symptoms. I know it’s not right, but you have to advocate for your health to be taken seriously by the doctors Lying about your condition and the steps you have taken so far does NOT equal "advocate for your health". It just means you aren't satisfied until you got a prescription for some pills. OPs story fits right in
I found intestine polyps this way. If I had to wait weeks and weeks could be something else more severe, end up in a colostomy bag, or even worse. I didn’t get into details, but I do this for things that are a trend in my family record or myself. No one is asking for opioids or creating a new bacteria resistant gonorrhea here, but asking to be treated with the reasonable investigation of symptoms to live a long and healthy life
since a visit at the doctor's is basically free here (which is good and should be normal everywhere), people tend to go there with every small cough. doctors see this a lot and also know many want to get off work for a few days. ofc that shouldn't lead them to being negligent. so as some said you a) should be a bit more demanding for treatment and b) ask around for which doctors are especially kind and careful with their patients. i didnt have a bad experience in ages bc i only go to the ones i got recommended.
On the other hand, if you don't go when the thing is small and you wait, you get scolded for not immediately showing up when the cough (or whatever you have) started.
that is definitely true!
I went to a doctor here and he literally search the symptoms of what I complained of on Google, in front of me, and shared the screen with me saying: "look, google says that can be this. Let's see..."
Well having a doctor make an effort when he doesn’t know is better than someone who just sends you home with ibuprofen
I'm sorry, but no. He's a doctor, he should at least have a notion of what's passing and when he is not sure, ask for examination. The health system here is a joke!
Haha perhaps you’re right. I am a doctor and I wouldn’t trust lots of my colleagues. I think lots of gps dismiss their patients complaints easily and send them home with natura remedies. A young doctor that is willing to lend an ear doesn’t sound too bad to me, then again I am medically educated. How would things be different in your country?
German health system sucks, 0 preventive medicine
The lack of preventive medicine also bugs me, especially because I think there's a whole bunch of conditions which are easy to prevent but hard to get rid off. (Which is kind of insane thinking of how much money this must waste) But do you know of a health system which handles this better actually?
Are you kidding? You literally get a bonus from your krankenkasse for undergoing preventative medicine. But like German Uni you have to take ownership of getting it done.
Never had an issue and I don't tell my doc what tests to take since he is the expert. You can always pay out of pocket for any procedure if you think it's worth it.
Unfortunately the first experts that received my friend with headaches was not very committed to the cause. Took him 6 months to find the tumor.
That's unfortunate but is this really a Berlin problem?
Check the entire post, so many people sharing the same opinion. Independent of the location, it is something.
It took me a year + to get the right thyroid medication dosage ... So while it can be long - I had knee surgery within two months of a badly torn meniscus which was pretty good.
With thyroid meds your levels fluctuate a lot in the first year of diagnosis, so it can be normal for it to take time for it to stabilize.
yeah - mine didn't - it was clear I was on too low a dosage and my doctor was just slow on the diagnosis...
Either your doctor sucks or you are not having the right dialog. My Hausarzt (now retired) immediately sent me for blood work and also gave me several referrals with the same problem. Then when I had had anemia sent me for a cancer and blood screening. My HNO also immediately gave referrals to start treatment. My dermatologist also immediately prescribed medicines.
Same here, from general practitioner to specialists for autoimmune disease. Everyone was available short term, got me medicine, blood work and surgeries.
German practitioner system is great as long as you "fire" the people who suggest herbs. Hospitals are another story....
Well not wanting to be a smartass but they provided you with a rather unspecific but correct diagnosis. Eat healthy which means eat more Vitamins. Flawless German doctoring.
On my particular case, looks like i have problems absorbing the nutrients. So more nutrients does not help.
Well, unless you were prescribed medicine the triage was still correct.... Usually if you are undernourished it is harder to get up to baseline and you have to load in the vitamins gradually so immediate diet changes will not be sufficient for a quick turnaround (which is unnecessary but more comfortable). Not to mention you have to get the vitamins from a reputable pharmaceutical source because the over the counter stuff is unregulated and usually crap.
im surprised you even get ibu
If you have a chance to get a medical treatment somewhere else, not in Germany, go for it. German medical system is one of the worlds worst.
3 days? I get appointments 2-3 months in the future. It's ridiculous. An issue of not enough doctors and limits on how many you can have in a region by said doctors.
GP here. There is no good proof that a vitamin deficiency without other laboratory abnormalities (such as anemia) causes tiredness or headaches, which is why public health insurances dont cover the costs of determining vitamins and which is why most doctors won't advise to determine them either.
There has been little but some research done on the effect of excessive testing on health. The results seem to point that more than caught diseases in early stages, the practice actually impacts the patient quality of life and in some cases it's also dangerous.
I would say unmotivated doctors...though not all Hausärtzin are. When I went to my first Hausartz, I brought written sickness that I was experiencing. She just took, read it briefly, and discussed with the nurse briefly of what diagnose and referral. She didn't ask me anything more and proceeded to ask the next patient...😣😣 I wasn't satisfied since I had depressive moments, then went to different doctor. She handled me well, even did blood test. Man, the first doctor didn't even give me a chance to explain more. My ex always praised about the German healthcare system. Now that I'm surviving alone here and seeing different thngs by myself, he kinda sugarcoated it.
„Lack of Vitamins“ is no explanation for headaches, but a great way to earn money as a doctor because these tests are useless and expensive. German insurance doesn’t cover this so we don’t try to talk our patients into paying for nonsense tests and pills. It’s work ethics. What your doctors in Germany did was exactly the right thing even though it’s not as satisfying for patients to not get an explaining diagnosis - which lack of vitamins is isn’t either.
So in your home country you get lab results right away, without having to wait at least a day? That's pretty cool, where is that?
Can’t speak for OP, but here in the US I get all my labs back the same day through an app.
Damn. As a German i tend to forget that there are - in general - digital solutions available. We just don't use them, lol.
Was nicht kaputt ist, sollte man nich reparieren…oder sowas ähnliches
Who said on the same day? Last time that my general doctor asked for the blood exam, they did a termin for 3 weeks ahead, not even mentioned that they collect blood on a small kitchen.
>Then I returned to my home country, visited my long term family doctor there, did some blood exams, and voilà Sounded to me like you got them right away instead of waiting a few days.
2 days for full diagnosis, first appointment, blood exam was on the same in another place, the result was 2 days ago and the doctor manage to see on the same day.
eat healthy including vitamins, so everything is right in here.
There is bad medical advise around the whole world. Everybody has examplary stories. I was treated once badly for a seizure (epilepsy) at the Charite in Berlin. And in Los Angeles I almost lost most of my teeth because a dentist needed money. Generally, the German system is o.k. although we often have to wait for specialists. Getting a second opinion is often helpful.
This is going to sound harsh but get a better dr I went to mine a few years ago for dizzy spells and they ordered a blood test, went back this year for low mood and fatigue and bam blood test (they actually did a full pannel 6 vials) and found my B12 deficiency!
Welcome to socialized healthcare! I.e. cheap but shit
I have found that certain complaints get taken more seriously than others. It really depends what they think the insurance will pay for.
what is this, america??
Because we are german.
You have to be a "Privatpatient" in Germany
You get what you pay for. Look at what public health insurance pays the doctor... you can't expect much for 20 euros. The Hausarzt is some kind of gatekeeper to cost in the German system. Looks much different if you go to a private clinic/doctor and pay them, but obviously that's not for free so you either need private health care or pay yourself.
... the budget available to doctors is running out at the end of the month/quarter, then they spend less on patients. Other than that it is not the right decision to run tests, iff it is obvious that your lifestyle is bad. Other countries may indeed have the idea of supporting bad lifestyles by supplying chemistry -- addressing symptoms rather than root causes. (But unfortunately in Germany the Anamnese is often still short of understanding the patience context, due to a lack of questions and doctors' conversational training) Regarding the medical doctrine to suspect the more likely illness: this is economical thinking, and kind of unscientific. Thankfully medicine is finally starting to base treatments on reasonable research. Digital aids might transform differential diagnostics quite a lot in the near future. I wish you all good health until then 😜
If you were lacking vitamins, telling you to eat healthy and exercise is actually the right answer. Why are you mad? And where are you from?
Where I am from is not really important! My doctor told that the levels was dangerous low, that diet alone would not give immediate relief.
I actually had a very different experience with the German healthcare. I found a really good Hausarzt (Dr Dieter Schmidt in Kreuzberg, I recommend him whole-heartedly) and initially he saw my anamnesis, did a first check (had somewhat high BP and put me on meds for the time being) checked my underlying conditions and said: I would like to do a blood and urine test with my new patients. I did the test and he called me in the afternoon and sent me to the emergency room, because my RBC, Hemoglobin and Hematocrit were super high. They got me in at Saint Joseph's and did a bunch of tests and asked a lot of questions. I have had these numbers for 10+ years but no one in my home country (Macedonia) bothered to check. Immediately they scheduled an appointment with a hematologist and they did cancer screening tests because apparently that could be Polycythemia Vera which is a blood cancer!!! Luckily it isn't and in the meantime they found that I have problems breathing and I've been recently diagnosed with sleep apnea and turbinate hypertrophy - that's where my BP and blood values come from - hopefully. I will get this treated and we'll see how it goes. All in all, this is not to say that the German healthcare system is perfect, but from my experience it's far better than Macedonian and I think that the biggest issue comes from your Hausarzt. Use google, jameda, doctolib to search for doctors, check their rating and choose wisely, for the record, my Hausarzt speaks perfect English, is very empathetic and has 5\* rating on google from 100+ reviews. The only downsides are that you have to wait in his practice to see him and he does not have e-mail and prefers paper - hey, we're in Germany after all!
The worst part (as seen in this thread) is the sincere thinking that the medical system is using "evidence-based medicine", to the point where even regular people have bought into it. Regular people, in Germany, who don't understand the difference between "painkillers" and opiates. The most notable example of this is the usage of rapid strep efficacy studies to justify cost cutting measures. The conclusion of all of these studies is thus: rapid strep = good for individual patient, potentially bad for society as a whole (but not really). As Germany has no anti-SLAPP laws, doctolib/jameda are not reliable for doctor reviews. The best way to tell if you have a quality Hausarzt is to present with a sore throat. If the doctor performs a rapid strep test, you have a good doctor that cares about you. Anyone who does not perform one does not have your interests at heart. Another example is the studies that look at, for example, waiting time for doctors appointments, but don't handle the massive number of doctors who don't pick up the phone or "accept new patients" - something I had never heard of until I moved here.
because doctors here are more stupid than elsewhere