Perceptions of Healthcare

Since coming to Germany as a permanent resident about 3 years ago, I’ve had the opportunity to experience healthcare here in its varied forms.  Just so you get a good idea of what I’m talking about I’ll give you a short rundown of healthcare events that have occurred to me and within my family (minus graphic descriptions):

  • physical examinations as part of healthcare insurance checks
  • joint problems
  • gallstones
  • infant surgery
  • child surgery
  • homebirth

If you are looking for me to pass judgement on healthcare here, I can’t fully satisfy you.

I’m not out to pass judgement on the system that I came from except to say that I am more satisfied with what I have now.  I won’t say that the care I received back in California was inadequate.  I will say it was more restrictive.

Both of our sons were born at home.  In the US, we had to pay for a midwife and all other expenses out of pocket.  In Germany (where homebirths are more accepted) insurance covered everything.  Finding a paediatrician with good social skills with the kids was easier in the US than in Germany.  The doctors in the US were more about educating their patients than just treatment…  the examples on how things are different can go on and on.  Suffice to say that there are differences and the levels of satisfaction have more to do with personal lifestyle preferences than anything else.

Having a good relationship with your doctor is always key.  We spent a great deal of time looking for a doctor for our kids, and we drive an extra half-hour to see one that can work with our kids and make them feel secure.  When time came for surgery for both, our doctor counseled us on the best hospital to send them to.  I’m glad he did that, because we had later need of a hospital he did not recommend… and the care there was not so good.  Our kids eventually went to the Children’s Hospital in Köln on Amsterdam Strasse (there is another one on the other side of the city) for their surgery. The care I would score as an 8 on a 1 to 10 scale.

The staff were friendly and knowledgeable with the exception of the clearly overburdened nightwatch… she (yes, just one nurse) was knowledgeable but lacked any social skills and was perhaps even a bit snippy.  Otherwise the surgery went off without a hitch and was well a few weeks later.

Insurance covered everything and was not a pain to deal with.  We are in the public system.  It was clear that patients on private insurance were getting earlier appointments (one week earlier), though.

A member of my family has been suffering from chronic abdominal pain for roughly 20 years.  She had been to see the best doctors over that time in Köln, in San Francisco and then again here in Mechernich (about an hour south of Köln).  None of them were able to concretely diagnose the problem and she had to live with regular bouts of crippling pain that would 2 or 3 days at a time.

One day a few weeks ago the pain got so bad that we called the emergency number who sent paramedics.  The system here is a bit different where if the problem is not immediately life threatening, the paramedics usually call for a mobile doctor to give advice or treatment… sometimes saving the patient a trip to the hospital.  In this case, the doctor did recommend a hospital trip but recommended one that is better for this type of problem.

The hospital is in Schleiden, which is a small town (perhaps 1000 people) west of us.  There, the doctor at this seemingly “backwoods” facility made a discovery.  Gallstones.  And he said the stones were not new.  It could have been that the pain all of these years was gallstones… a common and easily treated condition.  Had the other doctors missed it?  Well… yes.

However, after a bit of badmouthing the other doctors and hospitals (we were entitled to that) the doctor in Schleiden did say that while the stones could have been easily overlooked due to their size, the equipment with the sensitivityto detect these small stones was fairly new.  Were we to blame our doctors in California and Köln for incompetence or did they just not have the right equipment?  We’ll never know the answer to that.

We could have walked away casting blame about how bad the care was in the US, but it may just have been that the march of progress in medical techniques and equipment which is what really brought about the improvement in diagnosis.  I am tempted to praise these small seemingly unsophisticated medical facilities in the rural parts of Germany at the expense of the big city hospitals in the US, but that would be unfair.  I should also note the other doctors had recommended removing the gallbladder, although they could not say with certainty that was the problem. It turns out they were right, but they lacked the technology confirm their diagnosis.  Without a reasonable guarantee, we were hesitant to send a loved one in for surgery, no matter how common it is.

Healthcare, just like anything else, is what you make it and how you perceive it.  With persistence and assertiveness you can find the right care for you within the bounds of what is possible and reasonable, but sometimes at increased cost or effort.    Health insurance… that is a different topic.