Why do doctors seem to intimidate patients?

No more trouble with the doctors

A good week and a half before his death, the family doctor gave the resident of a care facility in Lower Saxony a flu shot. The 95-year-old was already dying. The authorizing daughter was not informed of this before or afterwards. Only when she saw the final private medical bill after her father's death did she find out about the vaccination.

Flu vaccination gray area

“It's such a classic,” says Ugur Cetinkaya, head of the SenVital senior citizens' residence in Ruhpolding, Bavaria. “Doctors often carry out flu vaccinations on their own without discussing this with relatives. This is a real gray area. ”Just as there is obviously a lot of trouble in the relationship between doctor, patient, nursing staff and relatives.

"Like gods in white"

"Typical conflicts between doctors and nurses are based, for example, on the disappearance of prescriptions, urgently needed medication or forgotten agreements when measuring blood pressure or blood sugar." but rather unannounced and usually do not consider the nursing staff at eye level. Cetinkaya: "They often act like gods in white." This problem exists especially in rural regions.

Finally specialists in the home

For his home in Ruhpolding, however, cooperation agreements ensure that doctors - including specialists such as neurologists, dentists and ophthalmologists - regularly come to the house. “Another urologist would be great. I have the feeling that the cooperation works better when the doctor is a little older. ”Perhaps then the understanding for the needs of the residents will grow. Or also the insight that regular home visits are now definitely worthwhile for the doctor?

Cooperations now without budgeting

Since 2016, budgeting for home visits has also been omitted if doctors conclude a coordination or cooperation agreement with the homes. Previously, the doctors were allowed to bill visits and treatments in the homes for each individual patient. But above a certain number no longer completely, but only reduced or “budgeted”, as it is called in technical jargon. That is the end of it now. "Doctors shouldn't be punished in the homes if they care for a lot of patients there," says a spokesman for the Techniker Krankenkasse.

With 50 home patients 2500 euros extra

With the addition of new fee schedule items, the cooperating family doctor now receives the same fee for each visit as for a normal visit. With 50 home patients, the doctor can earn an average additional fee of around 2500 euros every quarter, according to the German Association of General Practitioners.

Free choice of doctor remains

The aim of the contract is to improve cooperative and coordinated medical and nursing care for home patients. Unnecessary hospital admissions and rescue services are to be avoided as well as undesirable drug effects. This does not affect the patient's right to choose a doctor.

Further tips: “Doctors' evenings” in the home

Cetinkaya also recommends regular "doctor evenings". These meetings help him a lot to keep in touch with all the doctors in the region in his Upper Bavarian home. "The nursing and residential services are also there, and you can also address issues on an equal footing."

Can the doctor be reached on the mobile phone?

What the geriatric nurse and Düsseldorf blogger Dennis Zöphel also attaches great importance to: “The doctor should be easily accessible. It is important to me that I also have a cell phone number from him. Then you can briefly ask him personally when changing shifts if anything is unclear about a patient. Fast feedback is very important for spontaneous decisions. "

Does the doctor know anything about palliative medicine?

Zöphel also wants good palliative care from the family doctor in the home. “A lot of people don't do that, then the resident has to be transferred to the hospital for his last days and dies there instead of in the home he has already become familiar with.” The young nurse also cannot understand why family doctors have so much difficulty prescribing his Often times, take reasonable strong pain relievers like morphine. "It often seems to me that people with cognitive impairments are not as noticed and valued by doctors as those who can still express themselves." The nursing staff are asked here with a clear attitude.

Zöphel: Take a clear stance, don't accept everything

Zöphel also finds it difficult that relatives and caregivers often uncritically accept what the doctor says. A prime example of this is the intravenous administration of fluids at the end of life. “He or she must not die of thirst” is the motto. It has been shown that unwanted food and fluid intake unnecessarily complicates the dying process. "If, as a doctor, I don't feel like explaining this to the relatives, I'll just prescribe the liquid and everyone will be reassured." such a situation is indispensable.

Author: Birgitta vom Lehn

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