German health care system

[BoffinMum]

My DD is based both in the UK and US and has an EHIC card as well as being registered with a British GP. She works quite a bit of the time in the US and has expensive company health insurance provided for over there but frankly it is rubbish, like most US health insurance (I have been appalled by what goes on over there in the name of medicine). She is not due back in the UK for a few months.

Anyway, she has become ill and without going into gory details I think she needs a fairly through checkup along the lines of what the NHS would do here - blood, urine, female stuff, hormone levels, etc. The US doctors starting prescribing various clashing drugs apparently at random and basically did not have a bloody clue (according to my GP friends and the various relevant NHS websites). Evidence based medicine is just not known to half these people. Left to their own devices they would have finished her off, I reckon. She started to feel really crap on all the medicines and has just taken herself off them and feels temporarily better but we both think she needs to get to the bottom of the problem in order to sort herself out properly. She is very anxious about it all. There have been many tears.

She can't get back to the UK at the moment because of work (another long story), but she does have to fly to Munich to see a client soon. Would it technically be possible for her to use her EHIC card to see a GP there and get routine tests done, do you think? And how might we organise this?

I tried Googling private screening but that appears to be aimed at Russian oligarchs and the like and costs 1500-6000 euros plus includes some tests really aimed at older people.

Any advice welcome.

Try asking on the ToyTownGermany website. Lots of knowledgeable expats on there (not always the friendliest) but a good chance of an accurate answer.

The German health care system is nothing like the NHS btw, they will definitely want to charge someone, somewhere, probably a lot of money.

She could use her EHIC card and go to an Ambulante Klinik/ Walk-in but only about symptoms she was experiencing at that moment. I now have German health insurance (and with it German health care is excellent - German public insurance of the kind you either pay for directly from your salary or the govt pays for the unemployed is far superior in my experience to the NHS) but before we actually moved here I developed my first ever UTI on a trip over here and it was unbearable, so I went to a walk in clinic at a hospital and they did really extensive checks including an ultrasound of my kidneys before prescribing antibiotics.

She can't really ask for an investigation into a long term complex series of problems on an EHIC - but would be likely to get on the spot investigation of symptoms troubling her at the time of the Munich trip, so better than just random prescriptions based on guess work/ which drug company gives doctors the best perks... German GPs do simple blood tests and urine tests in house immediately while you wait, so you get the results there and then - those and ultrasounds would probably be available if appropriate, but not complex investigations.

It is my understanding that the reciprocal agreement between the UK and Germany entitles the holder of a EHIC card to 'emergency' and 'immediately necessary treatment', not to routine care or for investigations of an ongoing problem.

IMO she needs to prioritise her health and either get somebody to take an interest in the States (the home of Evidence Based Medicine, so it sounds like she may have had poor advice) OR come home to the UK and get sorted here.
She'd struggle to get anything coherent done while she's in Munich to see a client.

I am saying this as a UK GP with German qualification.

Agreed, EHIC is intended for emergency or urgent care. Not an ongoing condition requiring a prolonged period of investigation.

How much choice can she exercise under her US health insurance? Can she ask for recommendations from locals about who is the best doctor to see?

How often is she actually in the UK? She needs to be ordinarily resident here to qualify for free NHS treatment. I think in her circumstances I would be coming back to the UK to get sorted out, or insisting that her company give her access to the type of checkup you're describing.

Where is she in the US Boffin? Doesn't sound right that she hasn't had blood work done and they just prescribed stuff. I know it goes on and happened to DH once but he just changed doctors and self referred to a specialist after complaining to the insurance company.

IME insurance based systems (in the US and in Germany) lead to over- not under-investigation as a rule. So, yes, I agree, it's odd that she has not had tests done.

In the States, I mean.

My last post made sense in my head??

Pacific It depends. DH had an awful experience and I reported the doctor. I looked into their history and found they have qualified in South American and moved to the US once qualified. While they are able to pass the exams etc the training received isn't the same.

After speaking to a mother who is a qualified doctor (practices 4 days week and lectures one day a week here in the NYC area) I was told of the a vast difference in training. Now I am a medical school snob. If the doctor hasn't been a US or Canadian accredited medical school I don't let that doctor treat me unless an emergency or it's another medical school elsewhere in the world which is excellent. I always check with my friend though before letting them near me. We dropped our paediatrician as he trained at a school she didn't rank and the new one is far far better with preventative care with the DCs.

Superman - half of all doctors (including those at the posh colleges), graduated in the bottom 50% of their year.

That's interesting, Want2b.

Being neither British nor US qualified and yet bloody awesome at my job , I'll take it under advisement.

Oh, and btw, I think over-investigation can be just as (or in some cases even more) harmful than under-investigation, but that's for another fred.

Shines My point is that our experience has been that the doctor who trained at the south american school didn't have the same training so didn't think to do tests before prescribing. They also prescribed a couple of things that didn't go well together and luckily the pharmacist caught the issue right away.

I get that 50% of doctors graduate in the bottom of their year but this is about the training program in certain countries being quite different to the programs offered in the US and Canada (plus other Western countries) which results in the standard of care sometimes being lower.

Update: She is going to come back to the UK as soon as she can and see her usual GP. She's working in the US on a contract, but her main place of residence is the UK.

I do not think loads of tests are a good idea either, but I think in this case the GP will want to give her a checkup and certainly review medication. In the US the pharmacist did not pick up on the medicine clash which really got me worried. And when I tried to use her insurance company approved provider website to find a decent doctor for her, many of the people listed had comparatively limited training, and worked alone, which made me nervous. Very few had supplementary qualifications like our GPs often have (e.g. special interest in, say, diabetes or sports medicine or asthma). Care over there seems incredibly fragmented and from what I have seen, evidence-based care is in short supply, frankly.

I have been really shocked. It makes you appreciate the NHS, it really does.

Agreed. I have plenty to say about the NHS, particularly its poor management of complex, cross-specialty chronic conditions, but the idea of having to use the equivalent of Trip Advisor to pick a doctor fills me with horror.

How will she manage to stay in the country long enough for a series of tests, potentially over the course of several months, if that's what the GP wants to do? I hope her company will allow her to put her health first!

She is going to try to get a month off. They are a very nice company so might agree, not least because she has cancelled her last two holidays to accommodate them.

Hi op I don't know if you solved this but maybe your daughter could ask if she could pay for private blood tests in Germany ? I know you can pay for them where I am and they are not always as expensive as you think.

EHIC isn't designed for free medical tourism.

EHIC kind of assumes everyone is quite static, though, and doesn't really take into account people who have to work on contracts and move about a lot. You don't always get a lot of choice about that in the current employment climate, especially if you are just starting out and need to take what work you can.

If you have to move a lot you need private insurance (perhaps through your employer) rather than relying on national state schemes.

I am honestly shocked at what you have described -- I have lived in the US, Germany, Belgium, and the UK and the health care I received in the US was hands-down the best, by far.

I gather there are major problems with GP level care in some regions rooted in the approach of some insurance companies to their approved provider lists. So I think the care has become patchy.