The healthcare system in Berlin is, I feel, a little like the Wild West. Just as in the Wild West, there are certainly social and bureaucratic structures in place; everyone has a set role to fulfil, everyone knows their place and the whole macrocosm has a consistent rhythm. But also as in the Wild West, everything is a bit disorganised, generally everyone is a bit lawless, people’s cattle occasionally go missing, and you can’t stop groups of people from spontaneously launching into a bar brawl or a hoedown. Walking into a doctor’s practice is identical to the ‘walking into the saloon’ moment: the receptionists’ fingers stop tippy-tapping their keyboards and they turn to glare at you with suspicious eyes, the other patients suss you out from the waiting room, and you stand wide-stanced in the doorway, silhouetted in the daytime glare, trying to get a sense for whether or not this will turn out to be a quiet drink or a huge drunken punch-up with the gold prospectors in the corner. Metaphorically speaking.
If you have recently seen me diagonally lurching down the stairs or wincing when I sit down, the reason for this is that I have been suffering from a persistent case of tendonitis in the knee since April. Perhaps it would have cleared up by now if I had had adequate medical care earlier, but let us not wonder over ifs and maybes. But it is how it is, and here are the lessons we can learn from my latest journey through German medical care.
1. Sometimes you don’t need a referral if you need a specific doctor for a specific ailment (yay!) but sometimes you do (oh…okay?) and it’s not entirely clear when which case applies
So first of all I go to my GP to ask her what the heck I should be doing, since this is standard practice in the UK. See your GP, get sent to a specialist, done. Most doctors in Germany are independent and start their own practice, meaning that they are always completely fully booked because THEY ARE THE ONLY DOCTOR IN THE PRACTICE. Sometimes, however, you will find a Gesundheitszentrum where multiple doctors occupy the same building and take up miscellaneous straggler-patients when another doctor of the same category is too busy. This is how I ended up not being able to see my proper GP but her colleague, who simply looked at my knee with his eyes (pro tip to medics: if someone says something hurts, maybe poke it a couple of times to see if you learn anything). He leaned back, shrugged and went “A sports injury? Well I mean, why don’t you just look for taping tutorials on YouTube.” and then sent me out after a solid 5 seconds of professional medical advice.
2. Ok good, so if you have a muscle/joint type thing, you need to go to an Orthopäde, and that doesn’t require a referral
Nice, now we’re getting somewhere. There are several Orthopäden (orthopedic doctors) in my neighbourhood but they all have terrible Google ratings, so I just go to one which says they have open consultations on Fridays. I arrive on Friday morning half an hour before opening time just to make sure I am first in the queue, since these open consultations tend to be extremely full and you often end up waiting over two hours to be seen.
3. Open consultation hours at doctors’ practices tend to be extremely full and you often end up waiting over two hours to be seen – so be early
Get there early, sail through the door as soon as it is opened, and explain to the receptionist that you would like to see the doctor. In this case, the receptionist looks at me with a face of pure disgust and rants, “But today is appointments only!! Do you have an appointment???” I explain that I did not because I saw on the website that today was a ‘no appointments’ day. “Well that’s not correct, today is appointments only and YOU DON’T HAVE AN APPOINTMENT. You can’t just barge in here and expect to see the doctor!!” I apologise sincerely and say that I did not mean to cause any trouble but I had just acted according to the information I found on the website. “Well, you can’t expect everything that’s on the website to be a true fact, that’s not our responsibility.”
With this irrefutable conclusion, she turns to have a very serious whispered discussion with the other receptionists and they eventually agree to let me see the doctor anyway, for which of course I perform being undyingly grateful. After an hour the doc calls me in and makes me stand in front of him while he assesses me like a farmer sizing up a bull up for purchase. “You have terrible knock knees,” he announces. Then he gets me to lie on his ancient looking couch and wrenches my legs around before bashing them about with a reflex hammer until he is satisfied. He tells me he will prescribe me an MRI scan for my back (what?), orthopedic insoles for my knock-knees (cool, another physical flaw to be aesthetically ashamed of for the rest of my life, thanks) and physiotherapy for the injured knee. He then informs me that they have ‘run out’ of physiotherapy for this quarter so I have to come back at the beginning of July to pick up the prescription.
4. Apparently doctors get a limited number of ‘physio tokens’ that they’re allowed to hand out each quarter, so like, try to only get injured at the beginning of the quarter I guess.
I arrive at the practice at the beginning of July to pick up my prescription. On the front door of the surgery is an A4 printed sheet of paper:
“Practice closed for July due to holidays.”
5. It never hurts to get a second opinion
I show up for the open session at another Orthopäde and this time they don’t yell at me, which is a very positive start and I am feeling good about my chances. I am second in line when the practice opens and yet somehow I wait for over an hour and a half to be seen, while countless crumbling geriatrics shuffle in and out of the doctor’s room looking like no amount of physio would cure the fact that their skeleton has turned to granola.
This Orthopädin is nice! And helpul! And actually examines my knee, which (in case you forgot) was the one thing that was actually freakin hurting! She gives me a prescription for physio right away (I guess she had plenty of tokens). When I ask her if there is a particular physiotherapist she can recommend, she looks at me as if I had asked how many chickpeas she can fit in her earhole, so I wave the question away and leave on a high.
6. Physiotherapists are extremely in-demand and so you will have to work hard to get an appointment. Also, they never answer the phone.
So apparently all physiotherapists can’t afford a receptionist, which is why when you call any given practice around the city you will always get an answering machine message that says “Sorry, no one can come to the phone right now because we are currently administering treatment. Please call back later.” This is an extremely clever riddle because of course the physiotherapist is almost completely fully booked, so they will always be administering treatment when you call, so you will never get an appointment, EXCEPT IT DOESN’T MATTER BECAUSE THEY ARE FULLY BOOKED:
Nonetheless, I managed to finally find a very highly-rated dude down the road from my flat and he ANSWERED THE PHONE PRAISE JESUS and with a heavy sigh he agreed to squeeze me in.
7. Because most physicians are independent, they can decorate and run their practice however they damn well please
My physiotherapist’s practice is one of the least medically professional looking spaces I have ever laid eyes on. When you open the door, a motion-activated garden gnome wolf-whistles to announce your arrival (good God I wish I were joking). Most of the walls are encrusted with layers of pictures and posters and inkjet-printed signs, many of which display the price for various physiotherapeutic services, each in enormous text in a different font to any of the others. The other posters are either ‘humourous’ images like a photo of a hamster wearing a baseball cap, or diagrams of anatomical systems. On the counter there is a printed sign that says “Save the environment – say no to plastic! Card payments not accepted”. My eyes refocus and I see that the entire counter is encrusted with shiny posters, stickers and signs, that all say some variation of “CASH ONLY”. Is this guy above board? Do I care at this point?
When I present myself to ‘reception’ the guy looks up my appointment in a huge, yellowed ledger. I note that he does not have a computer. He ushers me into the treatment room and makes me stand one-legged on a huge foam slab to assess the state of my leg. He asks me where I am from and I mention with dismay that I am British, at which point his eyes light up, he turns to grab a squishy fabric ball made to look like an American football, and hurls it at me, yelling “RUGBY!!”. So this is how we spend the first fifteen minutes of the session: he throws a Not-Rugby ball at me while cheerfully shouting ‘Rugby’, I have to catch it, and then I have to throw it back while trying not to fall over. He is very talkative and tells me all about how much he loves the UK and thinks in particular that Ireland and Bournemouth are two of the greatest places on earth. I wonder a little about his judgement criteria, but I cannot think much about anything other than how difficult it is to stand on one leg any longer than a few seconds.
Then he asks me to lie down and he begins massaging my knee. This is my first professional massage ever and I must look awkward because he smiles at me and says, “Just relax. Lay back and think of Boris Johnson’.
We chuckle together. Internally I weep, although I am not sure whether that is for the thought of Boris Johnson or simply because sports massages are absolute Nightmare Agony.
8. Just find yourself a doctor who acts like a person and who also treats you like a person. Ideally one who can make a good joke.
