It’s time for a special edition of my Germany vs the US series–a side by side comparison of how hospitals work. How do I know this information, you ask? Well, last week my appendix decided it wanted out stat and I wound up having emergency surgery. Many thanks to Amy for taking care of business while I was recovering!
As most of you know, I’m a RN with a master’s degree in nursing. Even though I’m not currently practicing, spending four days in the hospital brought it all back to me. So many things are the same from one country’s health care system to the other (the smells, especially!), but I thought you’d enjoy hearing about some of the differences.
I’ll Be Here All Week
This was a really big difference–in the States, insurance companies want you in and out quickly because hospital days are expensive. I had a laparoscopic appendectomy, which probably would have gotten me a single overnight at home, but here I was an inpatient for three nights, and they wanted to keep me for four. I managed to talk them into discharging me a little early because my husband was going away on an extended work trip and at least wanted to get me settled at home before he left. Even with that, I had to promise to come back the next morning for lab work and an examination.
Here in Germany, health care is single payor and provided by the government, so there isn’t as much incentive to control costs. One friend told me that Germans look at hospitalizations as mini-vacations, which horrified me since like all health care professionals, I absolutely loathe hospitals (ask my husband how long it took me to even admit I had a hot appendix and agree to go to the ER to get checked out!).
Walking, Walking Everywhere
This one was funny to me since I well remember wheeling patients through the hospital to the various departments and even to the front door when they were being discharged. We don’t let people simply walk around the hospital because they might somehow hurt themselves! That’s not the case here.
In the ER, after they’d gotten my pain under control and determined that I was going to need surgery, they told me they were going to admit me. The resident asked me if I felt good enough to walk; I was flying high at that point and said that I did. She handed me my coat and purse, along with my paperwork, and told me to take the elevator to the ninth floor where I would find my bed! Off I toddled at 4am, high as a kite and still really bad at German, and went looking for my room. I found it eventually but definitely broke a sweat looking for it!
The next day, prior to surgery, my nurse sent me to find the anesthesia department so I could consult with an anesthesiologist. Once again, off I went with just a sheaf of papers in hand. I filled out a four-page questionnaire about (I think) my previous surgeries and experiences with anesthesia, filled in (I think) my allergies and height and weight (in kg and cm, so math was involved and I was still on drugs, mind you), and spoke with (I think) an anesthesiologist about what to expect. We used to chart that the “patient is a poor historian” in situations where they can’t give you enough information to make good decisions; I was 100% a poor historian in this case!
Experienced Doctors Cost Extra
Another interesting twist before my surgery involved the nice ladies who came up from the admitting department to talk about my private insurance coverage, since I’m not part of the German system. They needed me to find out what kind of doctor my plan allowed–and this was very important because it determined whether a resident would be taking my appendix out, or if I could expect someone with slightly more experience. Imagine my relief when my husband got back to me with the news that Tricare would cover even the head of the department as my surgeon! (Although to be honest, I was willing to take my own appendix out with a rusty spoon at that point just to feel better again.)
I could also opt to pay out of pocket for a private room if I wanted. I kind of liked the sweet little Oma I was sharing a room with, even though we couldn’t communicate, so I stayed put, although I did reconsider that decision the day they brought her a bedside commode to use. Our room didn’t have a curtain divider and, well, you can imagine the rest.
Hospital Food is Always Meh
A really nice lady came by to take my food order every day, but I will be honest that it always sounded better than it tasted (some things are universal).
I was, however, impressed by the fact that they cared deeply about my morning coffee–I could have cream, cold milk, or hot milk to go with it–and I felt like finally I had found people who understand just how important coffee is to life.
They also brought by a lovely fourth meal every day that I was allowed to eat–kaffee und kuchen (coffee and cake). It was still hospital-food cake, but cake nonetheless.
Pain is Relative
This part might only be interesting to those of you with a health care background, but their approach to pain control is different in a couple of ways. First, when I walked into the ER I was in serious pain and had been for hours. I thought it was significantly worse than childbirth, if that tells you anything! Well, they asked for my passport and a urine sample, and had me lie down on a gurney–in the middle of the hallway of course, because that’s how it works in the ER. Then, before anything else (and by anything I mean vital signs, an assessment of my abdomen, labs–anything), they put in an IV and gave me pain meds.
Now, as a patient in excruciating pain, I thought this was amazing, but as a nurse it was definitely different than what I was used to! By the time the surgical resident (I think) came to examine me and do an abdominal ultrasound, I was feeling absolutely fabulous. It all came out fine in the end, but it wasn’t the order I was used to.
As quickly as they put me on those pain meds, they wanted me off of them, which was a shame, really. I was allowed IV meds for about 12-18 hours after surgery, but then they pulled my IV and put me on something oral (I’m guessing like Percocet) for one day, and then it was nothing but paracetamol/Tylenol for me! It wasn’t unbearable, but it was more uncomfortable than I would have liked to wean down so quickly.
Take Your Things and Go!
When it was time to leave, they just handed me a copy of my labs and discharge summary and said goodbye. I picked up my bags, said goodbye to Oma, and walked outside by myself, just like I’d walked in.
The hospital is literally within walking distance of our apartment, but it’s all uphill, so I waited out front until my husband could drive down to get me. No sense dying immediately after leaving the hospital if you can help it.
The best part about the hospital is coming home!
So, while I wasn’t expecting the opportunity to experience the German hospital system, all’s well that ends well. The staff were all lovely and friendly, I’m healing well without any complications, and best of all, I didn’t die. I do have to wait until the end of the month before I can fly back to the States, though, so my daughter and I have shifted our plans.
The worst part of the whole experience was that I had to miss her high school graduation; to be honest I’m still really sad about that. But at least my husband was able to be there–he’s certainly had to miss a bunch of milestones over the years because of his work. Can you tell I’m trying to count my blessings instead of feeling disappointed?!
Now I’m off to rest–thanks for stopping by!
(See the other posts in this series here)