In Würzburg, doctors have been compelled to care for residents in homes affected by Corona. Two of them report – and say what they would like to change.
The city of Würzburg caused a sensation nationwide because it obliged general practitioners to take care of all patients in certain nursing homes. The city wanted fewer doctors to enter the homes, reducing the risk of corona infection. So the city was difficult Criticism of the National Association of Statutory Health Insurance Physicians a: Doctors are forced to neglect their own patients, the association said. The legal basis of the decision is questionable.
Among the first general practitioners to receive such a letter from the city were the Würzburg general practitioners Dr. Hannelore Schindler, Dr. Ulrich Horn and Dr. Mathias Vescovi. Together, they were to take care of the approximately 150 residents of Nikolausheim, where the coronavirus killed a particularly large number. In the interview, the 46- and 47-year-old general practitioners report what problems they initially had to deal with and what improvements they would like to see. Because if everything stays as it is, the well-being of the patients will suffer.
Photo: Kathrin Königl
–Question: How did you find out about your new commitment in Nikolausheim?
Dr. Ulrich Horn: At the end of March our practice received a letter from a courier. It was a kind of draft notice that stated that we had been solely responsible for the Nikolausheim since yesterday. We are obliged to make daily visits and to be available from 9 a.m. to 10 p.m. I found this letter very direct and almost objectionable – I communicated this to Lord Mayor Schuchardt. After all, the city has learned from this and has enclosed an accompanying letter in the following letters to colleagues. But I chalk the city that we were not included in advance.
Dr. Mathias Vescovi: That was also what initially led to the great outrage among the colleagues. You got that banged in front of the bib, according to the motto: “Go ahead!” And many questions remained unanswered. We did not know what that means for practice and for the employees and how it should all be done.
What challenges did you face from this decision?
Horn: From an organizational point of view, this is a big thing when suddenly you are responsible for a complete home every third day, have to familiarize yourself with new cases and at the same time have to manage your own practice, which under the current conditions is not so easy to manage anyway.
Vescovi: It took a long time to get an idea of strange patients in critical condition. Does the patient have to go to the hospital, can he stay in the home or does he need palliative care? In order to make these decisions, I also had to call many relatives I didn’t know before and try to get the patient’s actual GPs on the line. It was very time consuming. In addition, there were also fears among employees in their own practice that they had to take care of. After all, we suddenly had to take care of the home with the most corona cases in Lower Franconia.
Photo: Vescovi
–How did the patients react to suddenly having a new doctor?
Horn: In nursing homes, some of the patients are very demented and are no longer aware of this. But you have to explain all of this to the patients who perceive you. They ask, “Why are you coming now? I have another doctor.” It scares them even more than they already have. And besides, you are also masked. Regarding the legal, we have received no statement at all. Usually, every patient has the right to choose a doctor.
“There is no end in sight to this situation.”
Dr. Ulrich Horn, family doctor–The situation has calmed down. Do your practices remain responsible for the Nikolausheim?
Vescovi: These notices are limited until the disaster is lifted. But nobody knows when it will be. In this respect, the condition will continue for a longer time.
Horn: We gathered up and coped very well with it for a few weeks – mostly in our free time. The home is now Covid negative. This means that we only go to the home on demand. The problem is: there is no end to this situation. Patients cannot be adequately cared for by general practitioners. The family doctor takes care of diabetes, checks blood pressure and gives psychological attention. You can bathe everything. I can’t take care of many of the patients in this way because I don’t know them at all. As a result, Covid is well combated, but other diseases are neglected. The danger is that the collateral damage will eventually outweigh the benefits of Covid prevention.
How often are you currently in Nikolausheim?
Vescovi: It is very different. If there is no Corona case in the home, we do not have to make daily visits and are only on call. This is another problem because it is used very differently by nursing. What was communicated insufficiently: the emergency medical service is still allowed to go to the homes in emergency situations. We are only responsible when nothing works. The homes confuse that. Our service is in addition to the existing system.
Horn: Otherwise it is a very indirect support. The family doctor calls us in the practice and asks to visit his patient, whom he knows. I then go to the examination. Then I call the family doctor again and discuss the treatment. A lot of information is lost and it takes an infinitely long time.
What would a better system look like?
Horn: This system was tolerated because of the emergency situation. We all want to pull together. But now we have to think about what a promising system looks like. We’ll have to deal with Corona for quite a while. A constructive suggestion: there should be two to three doctors for a home who could take over the coordination there in the event of an epidemic. And for normal family care, you should let the family doctors back in normally.
Vescovi: For the homes where there are really corona cases, this was a sensible solution in the beginning. I think that we were in the home every day, also brought a lot of rest in with the foreign patients and with the care. But if you didn’t talk to us in the beginning, now. You can benefit from our experience and create a system in which the burden goes down from all shoulders. I would like that.
–
