General medicine
The general practice in Germany is one of the 33 disciplines of medicine . In English-speaking countries, general practitioners are referred to as General Practitioners (GP). The training paths and times differ from country to country.
statistics
As of December 31, 2017, there were around 43,500 recognized general practitioners in the Federal Republic of Germany, of which around 31,500 were general practitioners. In addition, general medical tasks are also performed by general practitioners and the emergency clinics of the hospitals. The number of practicing general practitioners who are also active in this sector without a field designation, still listed as “general practitioners and obstetricians” in the license to practice medicine , was only over 6,800 in 2017 and continues to decline. In the German Society for General Medicine and Family Medicine e. V. (DEGAM), the scientific society of general practitioners, 7,100 general practitioners are organized as members.
further education
The medical education of general practitioners is divided into training (study of human medicine), further training as a specialist in general medicine and further training as a specialist in general medicine. The training takes place in a structured form and is intended to deepen the necessary medical abilities and skills. The required content and training duration is determined by the regional medical associations, a (model) CPE regulations, general guidance is organized by the German Medical Association adopted. In the (model) further training regulations of 2018, a further training period of 60 months is provided, of which at least 24 months must be completed in outpatient primary care and at least 12 months in internal medicine in inpatient acute care. In addition, an 80-hour training course in basic psychosomatic care is part of the training.
Workspace
The work area of general medicine includes the basic care of all patients with physical and mental health disorders in acute and long-term care as well as essential areas of prevention (precaution) and rehabilitation. General practitioners specialize in being the first medical point of contact to advise on all health problems.
One of the tasks of general medicine is to recognize preventable, dangerous processes and to assign them to the appropriate specialist medical treatment. Another focus is the treatment of the chronically ill, in particular the care of high blood pressure patients and diabetics. The family doctor is usually the first point of contact for family medicine with often critical family histories and the resulting psychosocial conflicts.
The legislature has obliged the statutory health insurance companies to offer all their insured persons a family doctor rate. Among other things, the insured undertakes to consult the family doctor before a specialist visit and to only visit a specialist with a referral slip.
Fee schedule
In the meantime, the fee schedule and the entire care are divided into a general practitioner and specialist care area. The previously existing possibility that the general practitioner could provide and bill for all services has been eliminated by the fee schedule. This does not yet fully meet the legal requirements. Actually, the budgets , which are unavoidable with a limited amount of money, should also be divided according to a key that has yet to be defined. Understandably, both groups want as large a share as possible, or some kind of compensation, if the number of specialists continues to increase, as expected.
Working method
General practitioners claim to take into account the physical, psychological, social and ecological aspects of the patient. However, cost pressure and thus high throughput numbers, as well as a more somatically oriented training reduce the possibility of adequately implementing this claim.
Working basis
The working basis of general medicine is a long-term patient-doctor relationship and the patient's history, which is already recognizable from the social environment. The working basis also includes dealing with the epidemiological composition of the patients in a practice , which varies from place to place . The general practitioner should take this into account when making medical decisions.
Frequent occasions for advice
Work goal
The aim of general medicine is to provide high quality medical care for people. It also includes protecting the patient and society from inadequate, under- or oversupply. The technical and scientific issues are represented by the German Society for General Medicine and Family Medicine ( DEGAM ).
Work order
The work order of general medicine includes:
- the family doctor's filter and control function, in particular the appropriate stage diagnosis and therapy that is responsible for the patient and society, with the involvement of specialists;
- the family and family doctor function, in particular the care of the patient in the context of his family or social community, also in the home environment .
- the health education function, in particular health advice and promotion for individuals as well as in the community;
- the coordination and integration function, in particular the targeted assignment to specialists, the lead coordination between the care levels, the merging and evaluation of all results and their continuous documentation.
Great Britain (GB)
There is free health care in the UK organized by the National Health Service (NHS). Primary care is provided by the local general practitioner, the local pharmacist, dentist, optician and hearing care professional. In the UK, the general practitioner is responsible for all primary patients regardless of age or gender. Pregnancy care is not carried out by all general practitioners. The general practitioner is responsible for children. General practitioner care is regulated by the Royal Commission on the NHS, Chapter 7. In the UK, general practitioners can work in individual practices or in group practices. They are not direct employees of the NHS, but receive salaries and resources through Family Practitioner Committees (FPCs). The general practitioners are obliged to make house calls in addition to consultation hours. They organize a regional 24-hour on-call service. Patients cannot go straight to a hospital, but must first present themselves to their local general practitioner. This function is called "gatekeeping" in English, i.e. an access control to the hospital by the general practitioner. This access control to clinics by general practitioners is discussed very controversially in England, because it makes economic sense, but in urgent cases it delays inpatient admission.
See also
literature
- General Practice Regulations of the Westphalian Medical Association, version of April 9, 2005 in the version of July 9, 2011
- Journal for General Medicine (“ZfA”), organ of the German Society for General Medicine and Family Medicine eV (DEGAM) and the Society of University Teachers for General Medicine (GHA); published by Deutsches Ärzte-Verlag (Cologne)
- Journal of the general practitioner , advanced training and practice for the family doctor, Verlag Kirchheim + Co, Mainz, ISSN 0172-7249
- Frank H. Mader, Herbert Weißgerber: General medicine and practice. 6th edition. Springer, Berlin 2007, ISBN 978-3-540-71902-1 .
- Erwin Rebhandl, Susanne Rabady, Frank C. Mader: Evidence based Medicine-Guidelines for General Practice . Deutscher Ärzte-Verlag 2007, ISBN 978-3-7691-1241-2 .
- Michael M. Cooking, Dual Series "General Medicine and Family Medicine", Thieme-Verlag 2012, 4th edition
Web links
- German Society for General Medicine and Family Medicine
- Resolution of the annual general meeting of DEGAM (German Society for General Medicine and Family Medicine) on September 21, 2002
- List of university institutes and departments for general medicine in Germany
- ZFA / Journal for General Practice
- ÖGAM - Austrian Society for General Medicine
Individual evidence
- ↑ Medical statistics as of December 31, 2017. In: bundesaerztekammer.de. Retrieved November 22, 2019 .
- ↑ Outpatient doctors. Retrieved November 22, 2019 (German).
- ↑ German Medical Association, 2017 medical statistics
- ↑ (sample) training regulations. Retrieved July 19, 2019 .
- ↑ German Medical Association (Ed.): (Sample) Further Education Regulations 2018 . Berlin November 2018.
- ↑ Merrison, Alec, Sir, 1924-, Great Britain. Parliament .: Report . HM Stationery Off, London 1979, ISBN 0-10-176150-3 .
- ^ Geva Greenfield, Kimberley Foley, Azeem Majeed: Rethinking primary care's gatekeeper role . In: BMJ . September 23, 2016, ISSN 1756-1833 , p. i4803 , doi : 10.1136 / bmj.i4803 ( bmj.com [accessed October 31, 2019]).