Working as a doctor in another country to the one you trained in is a challenging but overwhelmingly rewarding experience. Those of my colleagues and friends who did a stint in a developing country devoted themselves to the community and its people and made a contribution that I remain in awe of. They came back with stories of exotic tropical diseases and shocking trauma wounds but also of the frustration of having limited resources and not being able to help patients in the way they were trained to do. In got the feeling that they were mostly glad to be back in Britain, and being given the chance to practise medicine to a standard they were used to.
My switch from the national health service to a German hospital was in no way a culture shock. Aside from the initial difficulty of communicating in German, I felt instantly at home on the ward. My doctor-patient encounters were as expected and my management plans didn’t differ greatly from colleagues. There were of course several differences, many small and some big. Here are a few that come to mind:
The majority of German doctors prescribe using brand names rather than generic names: the rather fabulous sounding Belok Zok was actually the beta-blocker Metoprolol and the commonly used Lasix was just the plain old diuretic Furosemide. Even if you decide to prescribe using generic names, you need to be familiar with the brand names too, as nurses and patients are more likely to know just the brand names.
Common laboratory tests are often conducted using a different measuring scale (for example blood sugar is measured in grams rather than moles), which took a while for my head to get around. Simple differences, which all the same made the initial few weeks even more challenging.
The equivalent of the BNF (British National Formulary) for prescribing is the ‚Rote Liste
‚ . The book itself is more the size of an encyclopedia, but the website is great.
White coats are pretty much obsolete in clinical practice in the UK, as they are thought to be nothing but a hygienic hazard. In Germany, you will not be acknowledged as a doctor if you don’t have a white coat on. More embarrassingly, you will often be expected to parade around in an unflattering pair of matching white trousers.
In Germany, graduating from medical school doesn’t automatically entitle you to the use of the title Doctor. For that you have to complete a research project (Doktorarbeit). Until then, you have to settle for being an ‚Arzt‘ but not a doctor.
The specialities are split up differently than in the UK. Psychiatry belongs to the Neurologists and is not a field of its own. Most general medicine specialists deal with the oncological care of the given organ themselves. For example lung specialists take care of lung cancer patients just as much as oncologists do.
You will spend almost as much time dictating detailed discharge letters as you will going on a ward round. The discharge letter is regarded as the visiting card of each hospital. And no German doctor enjoys writing one. There are urban myths of doctors who successfully stashed away patient files in elevator shafts in order to avoid writing discharge letters, but mostly, it’s an unpleasant job which cannot be escaped.
There are no house officers, senior house officers and registrars in Germany (or foundation doctors and specialist trainees as they are called now). This means you have to get used to doing pretty much all the jobs yourself, until you reach consultant level.
There are differences in ethical practices too. Recently, the law in the UK changed to make it legally binding for doctors to speak to patients/relative about their resuscitation status. To Germans, this newly enforced law would come as a surprise, seeing as it is common practice to talk openly about resuscitation with patients and relatives, whereas in the UK it is often seen as a purely medical decision.
Many more patients in Germany ask me about alternative medicine and herbal remedies than I was ever asked about in the UK.
In Germany, doctors are legally obliged to conduct a bed-side test of a patient’s blood group prior to transfusion before personally starting the infusion (and therefore assessing for any immediate reactions). This is simply another safety measure to prevent errors occurring blood transfusions, and although safety measures are in place in England too, this one isn’t. In some hospitals, doctors are required to hang up the first dose of an intravenous antibiotic.
Each state has it’s own medical governing body or ‚Ärztekammer‘. They are responsible for everything from licensing, accreditation, exams and learning opportunities. They too seem to follow the ‚Secret German customer service code of conduct‚, but are pivotal for the life of a doctor here.
I spent the first few months, (or if I’m honest years) stopping myself from saying the words „well in England, we did it like this“. I mostly felt that my way was better than the German way, just because it was the way I was brought up in the world of medicine. And change is difficult.
After 5 years of working in Germany (scarily, longer than my time in the NHS), I have come to value the fact that working in a different medical system allows a different perspective of care delivery and challenges the perceived norm. And sometimes we really should look to see what other countries are doing to see if we can learn from their experiences as well as from their mistakes, in order to find the best way.