German Medical Practice Practice In The Light Of Social Security

Northern Advocate, 5 July 1939, Page 5

German Medical Practice Practice In The Light Of Social Security

j' In view of the controversy over the Social Security Act, an article written I by an English doctor (Dr. Philipp) roj garding medical practice in Germany, lis interesting. Dr. Philipp acted as I a locum tenems for a busy general ! practitioner in a small industrial town j near Berlin. Regarding the panel sys- | tom in operation in Germany, he states | the patient can go to several doctors, ; as there is no list on which to put his name, which compels him to stick to his doctor for any long period. All he has to do is to ask his employer for a certain ticket, and to present it to any doctor who is willing and allowed to work for the panel. “Advantages and disadvantages of this system are obvious,” states Dr. Philipp." The competition of doctors among themselves in order to please the patient, is greater. |

“In Germany, not only the wage--1 : earners—including all up to a certain maximum of wages—are insured compulsorily for medical treatment, but j the insurance also covers their dei j pendants (wife, children, and other 1 family members), and furthermore exj tends to hospital treatment. In addi- , tion, not only practitioners work for ! the panel, but the specialists of every j/kind are engaged in the same way. j The insured person may present his j monthly ticket for treatment to any i specialist working under this scheme (and most of them do) in the same way as he would to the G.P. I feel inclined to call the average specialist in Germany not a consultant, but medical practitioner for diseases of the j heart, lungs, ears, or as the case may j be. This will bring the position of the j specialist at once nearer to the under- | standing of the English reader. It is a j striking difference from the specialist j in this country. I should, however, like to emphasise that the difference is i not one in training and scientific standard, but one in respect to the way of j , practice and social standard. The j I specialist in this country is a god-like |

I creature. He dwells in a special Olymj pia—Harley Street —his words are aweinspiring for patients as well as their doctors. The fees which he charges are alike! Socially he is on a distinctly higher pedestal than the G.P. Not so in Germany. There is no difference socially between a doctor whether he be trained to treat any special organ or the whole body. There is no Harley Street, either in Berlin or in any other town. The specialists are scattered all over the towns according to the needs of the population, exactly as the G.P.’s are. They charge their fees according to the district in which they practise, and these fees are on much the same level or only slightly higher than those of the G.P. I must exempt from this description only a few prominent specialists who are teachers at university hospitals or medical directors of some big municipal hospital. These have indeed j more the characteristics of the ‘consult- | ant,’ and in so far as there are only very few of them, they stand on a level of their own in the medical world.

“Apart from the national health insurance system, under which the working class population is compulsorily insured, there exist private insurance companies, the services of which are made use of on a much larger scale than is known in this country. A very lafge proportion of the middle-class population is insured in this way. The average income of a doctor and his standard of living is on much the same level as in England. The doctor’s, income—apart from the fees paid directly to him by private patients—also consists of quarterly sums from the insurance companies as well as from the panel administration —according to the number of patients and the amount of work done for them in the past quarter.

Hospitals. “The hospitals are run by the State, the Municipality, or are privately owned. This, of course, entails 1 a number of important differences. Every patient in a hospital has to pay for his upkeep—either as a private patient, or else, if he is insured, his contributions towards the insurance covers the cost of the hospital fee. Although in general the fees thus paid by the patients do not cover the entire expenses cf the hospital—the State or town has to contribute to it from taxes the patients do not feel that they accept chanty, but that they take by right what belongs to them. I feel that this is an advantage, and has by necessity an important counter-effect on the feeling of self-respect of the poorer population.

“There are—except in the case of teaching hospitals attached to the universities—no outpatient departments in the hospitals. I have pointed out before that the panel doctors, including specialists, see the patients in their consulting rooms; they will send them to the hospital only in cases where admission is necessary, but not for the purpose of consultation. “There are one or two other aspects in which the German hospital differs from the English one. For instance, none of the hospital staff in Germany works in an honorary capacity; everybody gets a salary, whether he be the medical director or a house surgeon. “I have already indicated that the average municipal hospital in Germany

fs a much larger unit than you find in this country. There are hardly any specialised hospitals. It is a strange sight for German eyes to see a hospital for ‘Cancer of the Rectum,’ or a hospital for nervous diseases, which exhibits cn largo street posters the different diagnoses qualifying the patient for admission, as you see in London. All the special departments are concentrated in one big unit. Hospitals having 1000, 1500 or even 2000 and more beds arc so created. The Rudolph Virchow Hospital, where I was assistant, had 2400 beds. There were nearly 100 resident doctors. A little town within itself. The case with which the different departments can work hand fn hand in such an organisation is certainly an important advantage. Present Day Germany,

“I gather that in the Germany of today, the medical outlook has greatly changed. Not only is academic life as a whole discouraged and the number of doctors on the decrease, but there is a decidedly different attitude towards patients and illnesses preached. The final aim being the ‘Healthy and Vigorous Nation.’ and not the healthy individual. The interest in curing the individual has greatly dropped, especially the interest in curing constitutional diseases such as disturbances of metabolism or mental disorders. ‘The Falling Must be Pushed,’ as Nietzsche pul it. A law exists today that sufferers from certain hereditary diseases have to bo sterilised —compulsorily, p necessary. You will find in the German medical periodicals today that articles on eugenics and research into hereditary diseases figure prominently, and encroach on the other branches of medicine.”