GP guide

General practitioners play a central role in healthcare: They are the number one point of contact for most physical and psychosocial problems. Accordingly, they offer a comprehensive range of treatments. GPs often accompany the whole family – even in crisis situations and throughout their lives. Everything you need to know about general practitioners.

Abstract

• General practitioners are the first point of contact (primary care physicians) for health problems; they do not work in an organization-centric way, but specialize in the whole person in their social, family and cultural environment.
• The “personal family doctor” is an important person of trust for almost 100 percent of patients in Germany, often for life or even for generations.
• A GP doesn’t have to be able to do “a bit of everything”, on the contrary: general practice and internal medicine are just as demanding as specialized high-tech medicine.
• In addition to their main role as primary psychosomatic care providers, GPs also provide care during individual episodes of illness, issue sick notes and certificates of incapacity for work, carry out vaccinations, make home visits and support their patients in makinglifestyle changes.
• If necessary, GPs cooperate with doctors and numerous other disciplines.
• General practitioners ensure care close to home with little effort.

General practice is family medicine

After studying human medicine, further training in general medicine includes acute and long-term treatment, prevention and rehabilitation of a patient’s physical and mental problems with a view to their biography, family, domestic and cultural environment – if necessary in trusting cooperation with other doctors.

In the role of general practitioner, a doctor of general practice – or internal medicine – has the following areas of activity, among others:

• General ongoing basic psychosomatic care for the patient, taking into account special life events
• Comprehensive coordination of all diagnoses, therapies and care measures in consultation with doctors
• Complete documentation of all treatment data, findings and reports from own and other specialist activities – including outpatient and inpatient treatment
• Preventive and/or rehabilitative measures, integration of non-medical assistance and accompanying services – e.g. vaccinations, therapeutic gymnastics, spa stays

Around 44,900 GPs were the first port of call for patients in Germany in 2020. However, the number of GPs is declining, as many medical students are not interested in the role of GP – especially not in rural areas.

Additional qualifications

If necessary, the GP will refer the patient to a specialist, although they may have specialized training or further training themselves. The classic additional qualifications include

• Ultrasound medicine: Examination of organic tissue using a so-called transducer and imaging techniques.
• Alternative or complementary medicine: Includes a broad spectrum of treatment methods beyond conventional medicine, for example acupuncture, homeopathy, osteopathy, traditional Chinese medicine, Kneipp therapy.
• Tropical medicine: prevention, detection and treatment of diseases from tropical and subtropical climate zones and their “import” into non-tropical countries.
• Geriatrics: Treatment of acute and chronic diseases in advanced age.
• Palliative care: Care for the seriously ill and dying with the aim of alleviating the consequences of the illness and improving quality of life when there is no longer any prospect of a cure.

The most common topics in everyday practice

General practitioners are the first point of contact for health problems; they do not work in an organization-centric way, but specialize in the whole person in their social, family and cultural environment. The work of GPs is correspondingly varied. As GPs work in practices and emergency services, they must be familiar with the whole range of possible illnesses, even if they ultimately refer a patient to a specialist or initiate inpatient treatment.

The most common diseases in everyday practice are

Since the turn of the millennium, mental illnesses have been on the rise in GP surgeries: Depression, anxiety disorders, addiction problems as consequences of a permanently stressed society in all areas of life, especially in the world of work. GPs are also the first port of call for burnout.

General practitioners also deal with the external care and treatment of injuries, for example minor accidents. General practitioners suture wounds and monitor the progress of wound healing.

With appropriate specializations, GPs are able to offer naturopathic therapies , although the costs are not generally covered by statutory health insurance.

Important person of trust

For almost 100 percent of patients in Germany, the “personal family doctor” is an important person of trust for the whole family, all age groups and genders – often for life or even across generations.

As he focuses on the entire life situation and life path of his patients, the discussion is not only of particular importance during the first contact, but also during the many years of support, which should be beneficial. Ideally, the patient is involved in the treatment and decision-making processes.

It is therefore important that your family doctor takes enough time for you and your concerns.

In addition, GPs are often the first port of call for relatives of the patient seeking help for a family member.

Not every GP offers a wide range of additional services or has comprehensive technical equipment. When choosing a family doctor, it can therefore make sense to opt for a group practice in which general practitioners and internists combine their expertise.

Diagnostics

As GPs are often confronted with initially diffuse complaints that cannot be assigned to a specialty, they often make a diagnosis based on their specialist experience.

First look and conversation

First of all, there is the “first glance diagnosis”. A good GP looks at you holistically, so to speak. Your description of symptoms is compared with patterns that he has already encountered during his career, and finally he selects the most likely diagnosis in view of your health condition, age and profession.

In addition to physical observation and examination, conversation – talking medicine – is the most important diagnostic tool. However, there is often little time to discuss questions and problems. As a patient, you can avoid misunderstandings and errors by asking questions or responding to ambiguities. Communication skills such as listening empathetically, communicating clearly and explaining effectively are now an integral part of medical training and further education. In the field of talking medicine, many things can also be clarified for doctors in the home office via telemedicine.

Physical examinations

• Viewing (inspection) of body parts, for example eyes, skin, tongue
• Listening (auscultation) using the stethoscope to check the sounds of breathing, heart and intestines
• Palpation of areas of the body in the event of pain for important indications, for example enlarged organs and altered tissue structures (lumps)
• Tapping (percussion) of the skin surface to find out about the density and size of the underlying organ and tissue, for example the heart, ribcage or abdomen

Functional tests

• Measurement of blood pressure and pulse
• Analysis of the blood – the so-called small or large blood count
• Examination of urine or stool samples
• Ultrasound (sonography) of the thyroid gland, leg veins, carotid artery, liver, spleen, kidneys
• Doppler sonography for heart disease, strokes, pregnancy
• Gastroscopy (gastroscopy)
• Resting and exercise ECG
• Long-term blood pressure measurements
• Functional diagnostics of the lungs
• Infusion therapy with vitamins and minerals to strengthen the immune system

Preventive examinations

• Cardiovascular check-up
• Skin cancer screening
• Youth protection investigations
• Vaccination and vaccination advice
• Travel medical advice (IGeL)

Sick note

In principle, the GP practice is the first point of contact for sick notes and certificates of incapacity for work. If, for example, you were in hospital because of an emergency, the doctors treating you there are not allowed to write you off sick – this is done by your family doctor or a doctor providing specialist further treatment. It is possible to obtain a sick bill retroactively for up to two days if you were unable to consult a doctor for health reasons. In such a situation, you can also ask a GP online.

Home visits

One area of GP work that is valued by patients is home visits, where acute and chronically ill patients are cared for. GPs can also meet the special requirements of elderly patients or provide palliative care for moribund (dying) patients. Another option is to speak to the GP via video consultation without having to visit the practice. TeleClinic or alternatives are suitable for this.

Questions and answers

Sources

• https://www.hausaerzteverband.de/fileadmin/user_upload/Perspektive_Hausarzt_-_Broschuere.pdf
• https://www.bundesaerztekammer.de/fileadmin/user_upload/downloads/BAeK_Ground_Hausarzt.pdf
• https://de.statista.com/statistik/daten/studie/191814/umfrage/anzahl-der-hausaerzte-in-deutschland/
• https://www.perspektive-hausarzt-bw.de/phnewsblog/weiterbildung-allgemeinmedizin/
• https://www.aerzteblatt.de/nachrichten/70760/Welche-Erkrankungen-niedergelassene-Aerzte-am-haeufigsten-behandeln
• https://www.apotheken-umschau.de/Medizin/Den-Arzt-wechseln-Geht-das-so-einfach-410595.html
• DEGAM_Position_paper_Psychosomatic_primary_care_final