National Preventive Mechanism 2.1.2 System-related problem areas Medical care Inadequate medical care The commissions found numerous problem areas in the field of health care. Based on the legislation in most of the Laender, operators of homes must ensure that residents can choose their doctors. As the commissions have observed, some in-house doctors are often overwhelmed with the diverse medical conditions of the elderly due to a lack of appropriate continuing education. Problems arise if specialists, for example for geriatrics, psychiatry or neurology, as well as therapists to optimise care, are not consulted in the institutions and facilities. The consequence is, for example, polypharmacy and/or prescription of unsuitable medications, as well as underestimating the effectiveness of non-drug treatments. It would be necessary to consider the interactions of somatic/cerebro-organic, psychological, biographical and social factors in the care of the elderly simply due to the increasing number of the elderly and persons requiring nursing care. The goal of geriatric impact analysis must be to achieve a great deal of what is still possible and not to lose resources and thus curtail the quality of life even further. Facility staff that notices deficits does not have any possibility to undertake effective intervention if the attending physician is not responsive or the legal guardians are not actively engaged. Duty to maintain patient confidentiality should not impede best possible care The commissions sometimes found that the attending physicians refused to provide important health information to the nursing staff, citing their duty to maintain patient confidentiality. There is no statutory basis stating that doctors must keep their records in nursing homes. The Nursing and Residential Homes Residence Act (Heimaufenthaltsgesetz) and the Healthcare and Nursing Act (Gesundheits- und Krankenpflegegesetz), however, assume cooperation of everyone in health-related professions with the nursing homes. The NPM has appealed to the Federal Ministry of Health in this regard, which has stated that another amendment to the Act on the Medical Profession (Ärztegesetz) is being considered for 2015 and that it will tackle the question of how to better support this. The NPM considers such an amendment to be urgently necessary. Likewise, solutions must be found for how to provide persons in nursing homes with adequate medical care by specialists. ¾¾ Free choice of doctor. ¾¾ Care by specialists and cooperation with facilities should be improved. 82