Physicians in outpatient practice

Neurology practice

Evidence from: DE, AT, CH

• Ask about complaints and review findings brought by the patient
• Perform a thorough neurological examination, including strength, sensation, reflexes, mobility and gait
• Draw up a treatment plan together with the patient and advise on helpful behaviour and follow-up checks
• Refer for X-ray, MRI or blood tests where needed and send reports to patients or referrers
• Prepare specialist neurological expert reports, for example on fitness to drive or on mental capacity for adult guardianship
• Lead specialist centres, for example for gait disorders and fall prevention, neurogeriatrics or Alzheimer's disease and memory disorders

General practice

Evidence from: DE, AT, CH

• Provide long-term GP care for chronically ill and older patients
• Provide acute care during consultation hours
• Carry out preventive check-ups including skin cancer screening and advise on vaccinations
• Perform minor surgical procedures
• Make home visits with basic geriatric care
• Perform and interpret device-based diagnostics such as ECG, ambulatory monitoring, spirometry and ultrasound

Cardiology practice

Evidence from: DE, AT, CH

• Perform and report echocardiography
• Perform exercise ECG as ergometry with 12-lead recording
• Record and evaluate resting ECG and Holter ECG
• Check pacemakers, ICDs and CRT systems, including remotely, assessing battery status and lead function and reprogramming where needed
• Contact patients promptly when remote interrogation shows abnormalities
• Take on acute and emergency referrals from the GP practice on the same day

Diabetology practice

Evidence from: DE, AT, CH

• Provide medical care for patients with type 1 and type 2 diabetes and adjust insulin therapy
• Initiate insulin pump therapy and provide long-term follow-up
• Oversee group and individual training on intensified insulin therapy together with diabetes educators
• Examine feet for polyneuropathy and circulation, including the ankle-brachial index
• Treat diabetic foot syndrome in a certified foot clinic with local wound care
• Care for insulin-dependent pregnant women with type 1 diabetes in cooperation with a perinatal centre

Ophthalmology practice

Evidence from: DE, AT, CH

• Determine visual acuity and prescribe glasses
• Carry out eye examinations for the mother-child health pass
• Carry out driving licence eye examinations
• Carry out visual field examinations and OCT diagnostics
• Fit contact lenses and carry out keratography and pachymetry
• Perform outpatient laser treatments in the office: selective laser trabeculoplasty for glaucoma, YAG laser for posterior capsule opacification and angle-closure glaucoma, argon laser coagulation for retinal diseases

Orthopaedic practice

Evidence from: DE, AT, CH

• As orthopaedic surgeons, perform arthroscopic joint surgery and knee, hip, foot and hand surgery
• Implant artificial joints
• Apply shockwave therapy and treat sports injuries, according to the source a focus of one specialist alongside hand surgery
• Provide follow-up care for fractures and injuries and give second opinions before operations
• Advise on CT-guided infiltrations at nerve roots and facet joints, which take place at a radiology cooperation partner, according to the source a focus of one specialist with long experience
• Take the history in conversation, clarify complaints and examine mobility, stability and function

Gynaecology practice

Evidence from: DE, AT, CH

• With approval from the regional association of statutory health insurance physicians, perform diagnostic colposcopies, document them using the international nomenclature and report findings to the patient, the referring practice and cytology
• Carry out screening examinations
• Perform ultrasound diagnostics
• Work up and treat hormonal disorders
• Provide care for pregnant women
• Carry out pregnancy examinations under the parent-child pass, including determining and documenting cervical length by transvaginal ultrasound at ultrasound examination 2

Urology practice

Evidence from: DE, AT, CH

• Perform ultrasound examinations, including 3D ultrasound
• Perform X-ray examinations
• Examine urethra and bladder endoscopically
• Perform urodynamic studies and uroflowmetry
• Diagnose and treat paediatric urological conditions, perform paediatric urological and endourological operations
• Treat urological cancers with medication, including chemotherapy

ENT practice

Evidence from: DE, AT, CH

• Take the medical history and examine the ears with a binocular ear microscope
• Carry out audiological differential diagnostics with pure-tone and speech audiometry, impedance measurement and uncomfortable loudness level, and perform or arrange additional procedures such as otoacoustic emissions
• Establish the indication for hearing aids, advise on technical options and prescribe hearing aids with patient-specific notes for the hearing care professional
• After fitting, check fit, wearing behaviour and findings, verify the proposed fitting with free-field audiometry and document the acceptance
• Adjust hearing aid settings personally in the shortened supply pathway (example of one facility)
• Perform outpatient procedures in the practice's own operating room where the practice is surgically active (example of one facility: formerly sinus, septum, middle ear and larynx procedures, now discontinued)

Dermatology practice

Evidence from: DE, AT, CH

• For balneophototherapy, establish the indication independently, treat acute side effects of the therapy and remain immediately available during treatment
• Practise surgical dermatology (example of one facility: physician's focus)
• Carry out skin cancer screening with an annual skin check
• Carry out laser therapies (example of one facility: physician's focus on laser medicine)
• Carry out allergy work-ups in children from age 6 and adults
• Accompany patients with skin cancer from initial assessment to long-term follow-up

Pulmonology practice

Evidence from: DE, AT, CH

• Care for patients with asthma and COPD in the structured treatment programme as physicians with pulmonology qualification
• Support smokers in quitting with brief intervention, individual or group counselling
• Perform pulmonology X-ray examinations with the required authorisation and regularly recertified specialist knowledge
• Closely supervise inhalation provocation tests as physicians
• Provide outpatient care for patients with asthma, COPD, chronic cough and sleep apnoea
• Hold the medical consultation based on the lung function measured beforehand

Paediatric practice

Evidence from: DE, AT, CH

• Carry out the child examinations of the parent-child pass (formerly mother-child pass)
• Perform infant hip ultrasound, given the appropriate training and equipment
• Well visits checking growth, development and overall health, including newborn care and breastfeeding and nutrition counselling
• Immunisations against vaccine-preventable diseases
• Sick visits for fever, respiratory, ear and urinary tract infections, gastrointestinal complaints, skin problems and minor injuries
• Management of chronic conditions such as asthma, allergies, sickle cell disease, high blood pressure, prediabetes, ADHD, anxiety and depression with scheduled follow-ups

Gastroenterology practice

Evidence from: DE, AT, CH

• Establish the indication for colonoscopies, independently perform total colonoscopies to the caecum and report the findings
• Remove polyps during colonoscopy with a high-frequency diathermy snare and send them for histology
• Document findings in writing and with still images, for polypectomy with images before and after the procedure
• Perform gastroscopies and colonoscopies, in the group practice exclusively by gastroenterologists
• Perform screening colonoscopies completely to the caecum
• Remove polyps in the same session where possible using a snare or forceps and take tissue samples where needed