A practice visit in Slovakia - the WONCA editor reports

Photo: Karen Flegg, Olgun Göktaş, Adriana Šimková, Jana Kotvasova (nurse) and Hagit Dascal-Weichhendler

During the recent WONCA Europe conference in Bratislava, the WONCA editor travelled outside the city to the nearby town of Pezinok on a visit to the practice of Dr Adriana Šimková. It was a multinational group with the editor being accompanied by colleagues Olgun Göktaş from Turkey and Hagit Dascal-Weichhendler from Israel.

On the day of our visit we saw Dr Šimková, another doctor and three practice nurses working. There is no appointment system so the patients turn up as they need and on the day of our visit there seemed to be quite a lot of patients in the waiting room considering the number of professionals available to see them. We felt just a little guilty that we were taking the attention of Dr Šimková. The doctor sees about 25 -30 patients per day and consultations usually last 10 to 15 minutes. It is usual that the nurses see the patients first, which no doubt makes the doctors’ jobs a little easier.

Those patients waiting were exposed to a range of health promotion posters which Dr Šimková had constructed herself for patient education purposes (see photo). The practice undertook a range of services not usual in a general practice, for example stress cardiographs, Holter ECG monitoring. The office was equipped with a lot of point-of-care testing(for example: CRP, INR, quantitative FOB test, urine analysis) and this which was augmented by the presence of a small laboratory on site. If these tests are not covered by public health insurance (as they are not always), the patient must pay extra.

A computerised record system existed but we did note the patients also appeared to have a paper file. Prescriptions are transmitted electronically to the pharmacist which is possible in a system where patients are enrolled in practices as they are in the Slovak Republic. Patients often take time to adjust to digitalisation, so there are still some who prefer to take a paper prescription.

This practice has about 4000 enrolled patients with two doctors. Dr Šimková told us that patients could change doctors if they wish after six months (or earlier under special conditions - for example moving to another city). Family doctors do not see paediatric patients up to the age of 18. However people can also wait until 28 years of age before moving from a paediatrician. This creates an interesting scenario where a young child and their parent could both be under the care of a paediatrician.

Our host, Dr Adriana Šimková, graciously responded to our many questions not only about her practice but about training and work as a family doctor, in the Slovak Republic. Dr Šimková has been in the current practice for seven years. She trained as a general practitioner for three years and then followed on with internal medicine training without sub- specialisation. This extra training in internal medicine seems to permit her to engage in a broader scope of practice (doing stress tests for example) and authorised her to have a broader prescribing remit than a normal family doctor.

On the occasion of our visit a patient presented her needed thyroxine and while Dr Šimková was able to oblige a general practitioner without the internal medicine training would not have been able to prescribe this. The three visitors found this somewhat unusual and felt that without the extra internal medicine training a general practitioner in this environment would have limited prescribing without the involvement of a specialist physician.

We did note however that general practitioners in this system are gatekeepers and need to be consulted for referral to specialist physicians.

The WONCA editor would like to thank our host Dr Šimková  (pictured) and her practice staff for graciously answering our questions and showing is not only the consulting area but also the laboratory and associated radiography facilities.