Treatment in Germany: when you need a coordinator and what he is responsible for

How to choose a surgeon, prepare examinations and organize rehabilitation after returning to Russia - a conversation about what tasks the patient can solve on his own, and what makes sense to transfer to specialists.

You can enroll in a foreign clinic directly. But after the first letter, other questions arise: which doctor to contact, whether the available examinations are enough, what is included in the preliminary cost and who will help organize the restoration of the house.

About these stages says Mikhail Marquart, founder of Medical Connections - a company that organizes diagnostics, treatment and rehabilitation in Germany, primarily in orthopedics and sports injuries.

Michael, let’s start with a skeptical question. You can write a letter to a German clinic yourself. Why pay the coordinator?

- Sometimes you really don't have to pay. If a person has already chosen a specialist, understands the purpose of the appeal and is ready to independently deal with documents, correspondence and travel, he may well do without additional support. Especially when it comes to one consultation.

I would first find out what kind of help the clinic provides. Perhaps its employees will take on a significant part of the organizational issues. It makes no sense to pay a second time for work that is already being done.

Another situation is when the patient does not yet understand who to contact, what materials to prepare and how to link consultation, examinations, treatment and recovery. The workload here is quite different.

- How to compare self-treatment and escort, so as not to overpay?

Two specific sets of services should be compared. What's the clinic doing? What's left for the patient? What tasks does the coordinator propose to undertake?

Suppose the doctor is found, the documents are prepared, the date of consultation is agreed. It is important to know what additional assistance is needed. And if you have to choose a narrow-profile specialist, collect the history of previous treatment and organize the work of several institutions, you need to evaluate the entire volume.

The word "accompaniment" in itself does not explain anything. It should be clear actions and responsibility for their implementation.

Many people imagine the coordinator as a person who meets at the airport and books a hotel. Where does your work really begin?

Often even with the diagnosis of the patient's place of residence. At Medical Connections, we don't just ask for a finished MRI. A person can contact before the examination and ask where it is best to perform the assigned study.

During the years of our work, we got acquainted with diagnostic centers in major Russian cities, where our patients received high-quality images. This experience helps to recommend where to turn, and to clarify the requirements of the receiving specialist in advance.

Meeting at the airport and accommodation can also be part of the escort. But a medical trip should be prepared much earlier.

- Why can't you just do an MRI in any convenient center?

It is important that the study meets the task set by the doctor. For orthopedics, the quality of images and the study protocol are important: sequences, planes and other parameters that allow assessing ligaments, meniscus, cartilage and bone structures.

Therefore, it is useful to find out in advance what materials are needed by a specialist who will analyze the case. The fact that the study is available does not yet answer the question of whether it is enough for a specific consultation.

So, the coordinator determines what kind of examination is needed?

Nope. The need for examination and its parameters are determined by medical specialists. We help to choose a center and organize the transfer of the requirements of the receiving doctor.

The coordinator does not assign studies, diagnose or interpret images. Our task is to help prepare materials with which the doctor will be able to deal with the situation in detail.

When choosing a surgeon, patients often look at the fame of the clinic. What do you recommend paying attention to?

First of all, you need to find out who exactly will perform the operation and what experience this doctor has with your problem.

I would ask the direct question, "How many of these operations do you do in a year?" Not operations at all, but interventions of the type offered to the patient. General experience and regular practice in a particular direction are different things.

If a meniscus is damaged, it is worth discussing possible treatment options and the reasons for choosing a specific solution. If we are talking about the anterior cruciate ligament, you need to find out the experience of the surgeon in such interventions.

The number of operations does not replace the conversation about indications, risks and alternatives. This is one of the issues that helps to make the discussion of qualifications more substantive.

Is this particularly important before re-operation?

It should be set before any operation, starting with the first.

Re-intervention can be much more difficult. For example, when reconstructing the anterior cruciate ligament, you have to take into account previous surgery and changes that have already occurred in the joint.

Organizing assistance after a previous intervention can also be difficult and expensive. We do not undertake to accompany each such case, we consider the possibility of working individually.

Therefore, the approach of “first I will do it here, and if something goes wrong, then I will redo it” I consider mistaken. It is important to choose the right specialist from the beginning.

- And how can a patient check that he is offered a suitable specialist, and not just a convenient clinic for the organizer?

- Ask to explain the choice. Why this particular doctor? How does his practice relate to a particular injury or illness? Who will study the documents, consult and, if necessary, operate?

The answer “this is a well-known clinic” is not enough. The patient must understand the logic of the recommendation.

I would be wary if instead of discussing the experience of a particular specialist, a person is offered only general promises. Questions about choosing a doctor are quite normal, they should not be shy.

- What else should be included in a clear escort?

Before the consultation, it is usually necessary to collect extracts, examination results and information about previous treatment, organize translation and transfer documents in the format that the clinic accepts.

Then agree on the date of admission, find out what surveys are needed before the trip, get a preliminary calculation and build a sequence of visits. If multiple institutions are involved, determine in advance who transfers the results from one specialist to another.

All this is worth describing in writing. Who keeps the correspondence? Will there be an interpreter for the consultation? Who should I contact if my schedule changes? What assistance is provided after discharge?

The same applies to documents for travel, accommodation and movement between institutions. The wording “solve all issues” sounds convenient, but the patient needs specific commitments.

- Let's get to the money. How to calculate the treatment budget correctly?

- I recommend dividing it into three parts.

The first is medical care. It is necessary to see what consultations, examinations and interventions are provided, how many days of stay are laid, whether follow-up is included.

The second is organizational work. What is included in the remuneration of the coordinator: assistance with the preparation of diagnostics, selection of a specialist, correspondence, translation, escort at receptions, interaction after discharge? Is there any assistance in choosing a rehabilitation center in Russia? Is there a time limit for escort?

The third is the cost of the trip: the road, accommodation outside the hospital, the costs of the accompanying person. If someone helps to book a hotel, it does not mean that accommodation is included in the named cost of treatment.

As long as these parts are not separated, it is difficult to compare sentences. The same total amount can mean a completely different composition of services.

Is it possible to get the final price in advance?

Preliminary estimates and final accounts are not always the same. The final costs may depend on the actual care provided and the change in the medical program.

Therefore, the important question is not only how much is worth, but also the following: under what circumstances can the amount change? How are the additional costs coordinated? What documents will the patient receive?

The promise to give the exact cost of complex treatments before studying medical materials should raise questions. Much more useful preliminary calculation with clear conditions.

Does working through a coordinator make treatment cheaper or more expensive?

- You can't say either in advance. Comparison of patient-specific offers with comparable services.

A low initial amount does not mean lower overall costs. First, check what is included and what is paid separately.

Any organizer should ask directly: how is his remuneration formed and who pays it? Where is the service of the clinic, and where is the organizational work? What medical bills and supporting documents will be available?

Transparency is more important than “all inclusive.” People need to understand who and what they pay for.

- And if the patient came with the expectation of surgery, but after the consultation the doctor does not recommend it?

This option should be discussed before payment. The decision on treatment is made by the doctor, and the consultation is not obliged to end with a recommendation to operate.

It is important to find out in advance what organizational services will be provided by this time, how payments are recalculated, and whether maintenance continues under another treatment plan.

These conditions must be clear from the contract. A verbal promise to “find it later” is not enough.

What happens after the patient returns to Russia? Is this where the coordinator's job ends?

Recovery should be discussed before the trip. What documents will be issued upon discharge? Who arranges the translation? Where will rehabilitation continue? How will the surgeon's recommendations get to the specialists at the place of residence?

We help to choose a rehabilitation center in Russia. For the patient, it is important not just to get a discharge, but to understand where to go next and how the stages of treatment will be related.

Restoring a home should not become an unexpected organizational task that a person begins to solve only after returning.

What are the recommendations of specific rehabilitation centers?

- Working together. In large cities, we have been working with certain teams for many years. With some centers we had dozens of patients in common, with some - hundreds.

Therefore, we take into account not only the list of services or the reputation of the institution. Important is how the interaction was built and the recovery experience of the patients we sent there.

Of course, this does not mean that you can guarantee the same result for each person. But such a recommendation is based on practical experience, and not only on information from the site of the center.

Who determines the rehabilitation program and answers medical questions?

- Specialists. The coordinator helps organize the transfer of information: documents about the operation, recommendations, restrictions. If rehabilitation specialists have questions, you need to understand how to contact the surgeon and arrange additional consultation.

We do not substitute doctors or prescribe a recovery program. Our job is to connect the participants and help the patient move through the next stage without organizational uncertainty.

Properly organizing rehabilitation for us is as important as helping with the diagnosis and selection of a surgeon. Accompanyment should not automatically end on the day of discharge from the clinic.

- What is the main question you would advise to ask before concluding a contract with the coordinator?

“What exactly are you going to do in my situation?” And then analyze the answer in stages: before the consultation, during treatment and after returning home.

Why is a specific specialist proposed? Who prepares the papers? What's in the price? What happens if the trip is rescheduled or the medical plan changes? What assistance is provided in Russia?

If the doctor is already found, the clinic helps with the organization, and the person is ready to independently deal with other issues, additional support may not be needed.

If you want to prepare a diagnosis, select a narrow-profile surgeon, coordinate treatment and organize recovery at the place of residence, you need to evaluate the entire amount of work. The patient pays for specific tasks and needs to know which ones will be fulfilled.