Comment by neuronic | Hacker News Reader

Comment by neuronic | Hacker News Reader

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As a "these-days person" I would generally like doctors with better bed side manners more than anything else.

In Germany, the healthcare system is readily accessible for people who are insured by one of the providers of national health insurance [1]. However, doctors need to process a large amount of patient per day to make ends meet.

Note, I chose the word "process" with intent, because that's what it feels like with 9 out of 10 doctors in Germany's cities nowadays. Go in, have a less than 1min chat about your health, get screened with a medical move set that rivals street food artists in Bangkok, then get a run-of-the-mill answer with little effort to personalize treatment according to your medical history.

The younger the doctors, the more intense is this issue. This isn't because younger doctors are less empathetic or something. The system simply demands this or else. People are more cattle than anything...

Oh and fitting right in with the Instagram fame, young medical professionals are all moving to the fun cities in Germany. Smaller towns and villages are hemorrhaging doctors. They are just not attractive in any way, especially with Germanys catastrophically bad Internet and mobile infrastructure.

[1] https://en.wikipedia.org/wiki/National_health_insurance

As much as Europeans love to crap on USA health care I have a polar opposite accedcdote.

Last time I was at my general doctor, I was in the room for an hour with Doc and nurse. Talking about how I’m eating, how I feel after running long distance, if this blemish has changed shape, how I’ve been sleeping, etc etc.

It took 10 days to make an appointment which is annoying, but I have never once felt rushed or that staff was rushed.

Like I said. Annecdote, but polar opposite.

Usually specialists are more like this, but not general practitioners. Also if you are privately insured you get premium service because the physician earns multiple times as much as from national health insurance. He now has time for you without jeopardizing his ability to pay off his office location.

Not too long ago, I still had my general physician who could sit down and talk it all through. He retired... and another one in another city did as well. Younger ones seem under much higher economic stress. Maybe also stress from peers?

It seems more of an emergent problem to be honest.

Yeah, I'm first to crap on US health care, but there are days I sort of understand why things in the States are the way they are. Almost everyone I know here (in Poland) tries to go for private care whenever they have spare cash, because public health care is pretty unpleasant and makes you waste a lot of time (+ you usually get scheduled for a visit many months in the future). This can actually be more expensive than private care if you count opportunity costs.

Recently my wife & I were forced to use the public service, and after 3 days of traveling back & forth, day after day, to another city, being told to visit another ward next day, and come back the day later, I was begging for someone to throw money at to make our problem go away. And I'm not really blaming the staff; they're all severely overworked, underequipped and underpaid. There's a huge problem with public health care here, kind of an opposite to the US problems. Poor or rich, you will get medical attention, just possibly months after when it's needed.

I was born in Poland. Yes the system sucks but US is on another level.

Imagine visiting a hospital for an emergency, and receiving 10 bills from different doctors totaling to few thousand dollars then fighting with insurance to pay for it.

Universal healthcare brings OVERALL cost down. It makes private treatment cheaper. A crown and root canal costs about $2k in the US. Plus, it is nearly impossible to find cost of a procedure prior to it. It is fking weird.

Uh ok. Thanks for the perspective. I guess we are better off, because private healthcare here is straightforward and not that expensive for the basics. For a root canal here I paid maybe 200 USD in total.

> For a root canal here I paid maybe 200 USD in total.

For comparison, with insurance in the US my root canal cost about $250 out of pocket.

I have dental, paid $350 for root + $300 for crown. It covers 50%.

I paid ~$200 with no insurance whatsoever.

Interesting. I looked around Chicago area and the cheapest I found was $350 just for root canal.

I'm also from Germany, and going through some treatments right now (Surgery/Orthopedics) and I think this comment is too harsh. It overemphasises that some doctors may seem arrogant, or staff may have a negative attitude.

For instance Internet connectivity is not "catastrophically" bad, (could indeed be better, though).

An overlooked trend that has has changed communication patterns with patients for the worse is a trend towards larger joint practices with doctors as employees often not working fulltime. Joint practices tend to have larger, fuller waiting rooms, and which necessarily results in (in my experience) a more stressful doctor-visiting atmosphere.

Moreover, paperwork has become more complex also for patients, e.g. when agreements and waivers (for operations) have to be signed, nobody has the time to explain these. Nobody can explain finer points of medicine prescriptions, and usage of technical helping equipments (e.g. hearing aids). The staff at the front desk can't explain this, and the doctors do not have the time to either.

These are all general problems, not Germany-specific.

I tend to agree with you, even about my comment being a bit harsh. It's not like I want to attribute malice to physicians. The system just cannot operate smoothly under its current load and structure.

However, I heavily disagree about Internet connectivity. In cities like BER, HAM or MUC it is "meh". On the country-side and in smaller towns it is catastrophically bad for the 4th largest economy on the planet.

This is Deutsche Telekom's fiber network in Hamburg, today: https://i.redd.it/r4a07co2x4y11.png

Do you have physician's assistants (PA) in Germany? Sort of between a nurse and an MD. I've found for general care, they strike a reasonable balance. And it really doesn't take an MD to tell me I have a sinus infection and hand me a pack of anti-biotics (or anything similar).

I know, my gf in the US used to be a PA. We do not have this exact position but others are filling it in a way. It's generally a slightly different structure.

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