02 October 2011

Quest for a doctor


Not unreasonably, most English people will generally sneer at the level of bureaucracy encountered on the continent. But try to register with a GP (which, for those unfamiliar with the country, stands for General Practitioner, basically family doctor) in the Land of Hope and Glory and you may be up against the most centralised, bureaucratic, archaic system known to man.

In England, GPs are assigned strictly according to where you live. Just to give you an idea, a few years back I moved house within the same large English city, from one area to another. Months later, as I called in at my GP’s reception to book an appointment, they remarked that – because I’d moved area- I would be seen that one last time but that it was mandatory for me to re-register somewhere closer to my new abode.

And so the quest began. Overall, the whole process of wandering about and knocking on doctors’ doors took an entire morning off work.

It turned out that, in the inner city area in question, there were only four medical surgeries to draw from, except that three out of the first three health centres I tried turned me down on the basis of being already packed with patients.

However, I was lucky to be taken on board by choice no.4, courtesy of a smiling and polite receptionist. What a shame though, that her good manners didn’t tie in with the doctor’s. As I discovered on my first visit a few months later, the man turned out to be the most unnecessarily miserable, rudest, hostile GP of all my life. An absolute cunt, basically, to the point that –on my way out - I looked for complaint forms (a very English thing, as we’ll see later). In vain, of course.

On another level, and in spite of the industrial political tampering of the NHS that’s been going on for years, the Health Service in England continues to be absolutely free of charge for all patients, which I think it’s something the nation should be proud of.


The surprise, instead, came from Italy. A notorious bureaucratic nightmare when it comes to anything related to public services, Italy proved extremely easy in terms of registering with a GP.

Now. Admittedly, I’m talking about a small city in the Northern part of the country, one known for its exceptional levels of efficiency and organisation, so I don’t know if you’d enjoy similar luck in Rome or Naples.

The fact is, however, it took me literally five minutes to walk into a super clean and nice-looking office based at the main hospital, where a receptionist asked me where I lived and produced a list of doctors categorised according to the district and asked me which one I’d prefer.

She typed my answer into a computer and told me about the opening hours and how to book an appointment when needed. Five minutes, that was it.

While GPs in Italy are free of charge, medical care at A&Es department may be subjected to a small fee. The scandal, however, is how much people (especially civil servants and local authority workers) are penalised when they call in sick. Courtesy of a recent law brought in by the Berlusconi government, five Euros per day of absence (up to a total of ten days) will be deducted from your monthly salary. In other words, not only are you feeling poorly, the government will also bash you round the head so that next time you’ll think twice before catching that bug, you lazy layabout.

Most English people will be struck by the fact that most Italians GPs are based in flats. Literally. Just any block of flats. One of the apartments will basically be converted into a simple medical practice with a reception, a small waiting room, and the doctor’s room. It makes you wonder what they do with the kitchen.


In Spain, the concept of a GP is not immediately understood. In most places, the so-called medico de cabezera is based at a huge clinic/not so small hospital (Centro de Assistencia Medica in some areas, or CAP – I don’t know what it stands for, in Catalunya).

What you need to do, therefore, is locate your nearest clinic and head there armed with passport, identity number (NIE, for foreigners) and empadronamiento (a certificate of residence within the local council). Provided you don’t leave any of them at home, the registration is fairly quick and you will be assigned a doctor based at one of those hospitals. A good thing is that you’re not expected to stick to any specific centre as there’s ‘geographical flexibility’, so to speak.

When you book an appointment, expect up to three days until you can be seen. You will be impressed by the cleanliness and modernity of the clinics. Most look really spotless and well signposted. As for the doctors, it really depends on individual circumstances, but don’t expect English to be spoken. Most generally can’t – and why should they.

Oh. Like in England, medical care in Spain is also totally free at the point of use and you don't miss out on cash if you call in sick (though see Employment and Tax Dodging).


In common with Italy, your Hausarzt will also operate from a flat. A plaque hanging at the entrance, will inform you that Dr X or Y is on the 1st floor or other. Their surgeries, however, will impress you for their efficiency (what else) and modernity. Waiting rooms are generally supplied with self-service coffee machines and water coolers. All free, of course.

What isn’t totally free, however, is the health system as a whole. Germany here contains seeds of Americanism.

By law, every resident has to sign up with a Krankenkasse of choice. A Krankenkasse is a for-profit health insurance organisation that will cover your costs whenever you need to be seen by a doctor.

In general, they don’t come cheap. Those who work in Germany know that a scary chunk of your monthly salary is automatically taken to cover your health insurance (your employer will cover more or less half of it).

But that isn’t all. Courtesy of a law passed in 2007, now each time you require the services of a doctor you will have to fork out ten Euros. This works on a quarterly basis, meaning that if you go to the same doctor in January and then again in February, you will only pay once. Beware though. This doesn’t apply to Emergency care where they will ask you for a tenner regardless.

I have no idea what happens if you don’t have any money on you. I guess they make you sign a promise to pay or something, which may pose a problem if you’re unconscious.

On the plus side, apart from the extreme cleanliness and efficiency of both Hausarzt surgeries and specialist clinics, most of them are very sympathetic if your German is not up to scratch. Most doctors and nurses speak amazing English, even though they will tell you in self-deprecating fashion that it’s not true and they only do “a little bit” (which is typical of almost every German: “Sprechen Sie English?”. “A little bit”, the classic reply)

On an even better level, you are totally free to pick your doctor. You can literally reside in Berlin and choose to have your GP in Frankfurt and so on. Why you’d want to do so is another story, but at least – tenner in hand - you’re guaranteed medical care wherever you are. Particularly handy if you find your GP’s rudeness impossible to put up with.

As it’s in the interest of most German doctors to retain their patients lest they take their custom and their 10-Euro notes elsewhere, I guess this is one area of market competition that is working.


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