Change doctor: is it that easy?
What you should consider when changing your family doctor, referring a specialist and obtaining a second opinion
When Werner Hofer moved from Hamburg to Berlin a few years ago, where his daughter lives, he inevitably had to look for a new family doctor - and quickly found what he was looking for. A practice community that also includes an internist, and all of this very close to his new apartment. For the pensioner who suffers from a heart failure and is therefore no longer so good on his feet, two powerful arguments.
For a long time he felt in good hands there. But then his doctor diagnosed a harmless flu-like infection, which developed into severe pneumonia. Werner Hofer doesn't even believe that the doctor really made a mistake, but still "it lost my trust in him," he says. That is why Hofer would now like to switch to another general practitioner whom acquaintances have warmly recommended. But is that even possible? And if so, what do you have to consider?
Free choice of doctor enshrined in law
Heike Morris, legal director of the Independent Patient Advisory Service Germany (UPD), is confronted with these questions more often. "Patients are increasingly unsure whether a change is uncomplicated, especially since the statutory health insurance companies have started offering general practitioner contracts and so-called disease management programs."
The legal situation is initially clear, because in Germany there is the right to a free choice of doctor. That means that every patient insured with the statutory health insurance can choose the one to whom he or she would like to go from among the general practitioners who are resident and participating in statutory health insurance. And he is allowed to change the doctor, "a reason or explanation is not necessary," as Heike Morris emphasizes. However, the doctor should only be changed within a quarter if there is an important reason.
The right to a free choice of doctor applies equally to those with private health insurance. Morris advises all patients to exercise this right if necessary. "Because the doctor-patient relationship presupposes trust. If this is permanently shaken, the cornerstone for treatment is missing."
Is it possible to change despite a family doctor contract?
If the patient takes part in a family doctor or primary doctor model (so-called family doctor-centered care, participation is voluntary), the change becomes more complicated. With this care concept, which the statutory health insurances have to have in their offer since June 2009, a doctor acts as the first point of contact and guide through the jungle of the health care system.
This primary doctor remains freely selectable. "For the duration of the contract, this doctor should always be consulted first," explains Morris.In return, the health insurances can offer the insured person special services and premiums.
Pay attention to notice periods in the contract
The terms vary depending on the health insurance company, but are at least one year. More details are in the contract. As well as the notice periods, which - if you want to get out of the program - should be observed, otherwise the term is automatically extended. Participants are not allowed to simply change the primary doctor during the period of the contract. Or only if there is an important reason. This includes, for example, the relocation of the doctor's practice or the insured person himself.
But what if the patient simply does not feel that they are in good hands and treated by the chosen doctor? In this case, Heike Morris advises on the one hand to contact your own health insurance company. The health insurance company can help find solutions. However, the condition for a change is that the new doctor also has a contract with the patient's health insurance company.
On the other hand, the employees of the Independent Patient Counseling Germany can also help, who advise those seeking advice free of charge and on behalf of the law. For example, it is possible to revoke the declaration of participation in writing, "if, for example, your gut feeling is no longer right within the first two weeks," explains the expert.
In addition, the patient still has the right to extraordinary termination, for example in the event of irreconcilable differences.
Right to surrender the patient file
In order to avoid possible complications, the Independent Patient Advisory Service recommends that you take all documents about previous illnesses and previous examinations with you when changing family doctor. Patients have the right to have a copy of their patient file. The second way is to ask the new family doctor to request the documents from the old practice.
The principle of freedom also applies to the choice of a specialist. This can already be seen from the fact that the patient is not referred to a specific person, but rather to a doctor from a specific discipline. People without a family doctor contract can go to a specialist without a referral. If you take part in a care program, you are only allowed to go directly to representatives of certain disciplines - such as the gynecologist, ophthalmologist or pediatrician.
Right to a second opinion: Yes - before certain operations
The situation is very similar if the patient wants to get a second opinion. In particular, before any pending operations, many people want to secure themselves through the assessment of a second specialist. The expert explains: "Since mid-2015, patients with statutory health insurance have a legal right to a second opinion before certain predictable and quantity-sensitive operations, such as tonsil operations or hysterectomy."
The legislature has recognized that there is a risk that the decision on the operation can also be guided by the hospital's economic interests. The patient information sheet of the joint federal committee provides further information: https://www.g-ba.de/downloads/17-98-4765/2019-10-28_G-BA_Patientenmerkblatt_Zweitmeinungsverfahren_bf.pdf.
A doctor with approval for a second opinion can be found at https://www.116117.de/de/zweitmeinung.php.