Rheumatoid arthritis treatment in 46 Oncology and Orthopedic surgery clinics in Germany

They don’t give an estimated waiting time for surgery- they kept pushing my surgery. I had to stay without eating any food or drinking any water for 24+ hours as they kept pushing my surgery. But overall the staff and doctors are very kind. They took care of me really well even though I didn’t speak German!

This place really deserves 0 stars. I’m sure there are hospitals in third world countries that have better service than this place. First of all, the Emergency Room receptionists don’t speak even basic English . Which is unbelievable being in a large international city with a high population of foreigners. They were basically unsympathetic and useless despite me being doubled over in pain. Where do I even begin with what I experienced here? I was admitted at 5am on Monday morning. The place was empty. Despite this, no one ever came to check on me for hours after putting in my IV and I woke up to it sucking my blood out. My toilet didn’t work which was a nightmare with constant vomiting and diarrhea . There was no toilet paper and despite me bringing this up to someone several times throughout the night it was never replaced. Because I had no way to flush the toilet or given any alternatives (even a trash can to vomit in would have been nice) I was forced to just keep stacking all my expulsions into the blocked toilet. For my second IV the nurses put it in wrong, no one noticed until the doctor came in hours later and saw it. I decided to discharge myself and when I left I saw all the nurses and support staff in the hallway chatting about their weekends and playing around on their phones. Absolutely despicable. Since this has been noted by several other reviewers, I believe there needs to be some firing of personnel and change of management. The room itself was also very unhygienic and reeked of urine and homelessness (similar to Hauptbahnhof) which made my already bad nausea even worse 🤮🤮🤢. The negligence at this hospital is out of this world and should be called out.

My sister had a serious operation in this hospital 4 days ago. After the operation, she spent the first night in the intensive care unit. My sister was very satisfied with the treatment in that department and felt calm. After transferring to the public sector, everyone is still very kind and helpful. Very clean hospital, with professional and lovely staff. And also the atmosphere is beautiful.

My mother had the chance to lie there for a short time because she had a brain tumor, but we could have left it alone because she was very unhappy there. The doctors were great, but many of the staff were a disaster in the early rehab. I saw my mother lying on the floor during visiting hours and she screamed for ages until someone came, even though the door was open and I opened her in fear was found on the operated side and this is said to have happened often, even though the rehab is better staffed than the other wards and then she was transported to the hospice without giving me the information, which I found really annoying. The doctors and the ward managers, the therapists were great and there was also a colleague who my mother really liked, but the rest was unfortunately a flop.

I can only say good things about dermatology. All the nurses and all the doctors are incredibly friendly and competent.

Dated decor here and there, especially the rooms. I was successfully helped. A wonderful park where you always like to go for a walk....even after your stay. Many old half-timbered houses, all of which belong to the Klinikum Bremen Ost. Various therapies take place there.

Completely rude and incompetent stuff , I went once to emergency , as I am first time pregnant and I had huge bleeding in the start of my pregnancy , the women on the desk she saw how terrified I am but kept saying me it’s better to wait and go to see your doctor (my doctor was closed that day ) then with really rude attitude she finally accept as . PS: the emergency was totally empty only one women was there waiting Today I called again to take appointment for giving birth (they remind me that I should not give birth here ) the first guy who picked my call he just transferred the call without saying any word , no hallo even , the second women since the start of my call she kept saying in German I cannot understand I cannot understand! And I just said hello , my name is hana nothing else ( in German ) I said sorry my German is not so good and I repeated my sentence and she said again I cannot understand call again and just cut my call !! Ok I am not a native German speaker and maybe I have accent but that’s totally normal and I know that I am talking correct German at least make some effort and talk correct to people !!! Have some manners !!

The staff at the primary care clinic was so friendly and professional, but once I got to the oncology department the staff were bigoted unprofessional and abusive.

My wife had a very strong headache. With "very strong headache" I mean - she couldn't talk, walk normaly. At the reception she answered a lot of questions. We were by family doctor. She had already the referral slip for MRI. They took blood and gave her something that had a little helped. They denied to make the MRI because of missing plausible Reason. They didn't check even the blood pressure. All my wife saw in this Emergency was only indifference and loss of care. How we must be sure that we will live a long healthy life, when the persons who are paid for that don't take reasonable steps to prevent a Death? Shame on german Health System. I recommend to search for another Emergency Point in the City. At Uniklinikum you have a very big chance to die. And they will say - "we didn't know" or another stupid argument. This happened on 28.10.2022. We came at 17:00 and left at 22:00. Besides - they found nothing.

I had a great experience giving birth at UKE. everyone working there was super nice, cooperative and friendly at the registration and at the Kreißaal as well as in the postpartum care. We requested the family room, which became available in few hours post our request ( you do need to keep following up the availability status of the room til you get it though ) For the mom, you need to get a shirt/ dress to give birth in. And pjs for afterwards as well as the bathing supplies For the baby, you will only need to have the go home outfit and maybe a pacifier. All else will be supplied by the hospital. The meals served are really good too. Not the typical tasteless hospital food .. you will need to have some snacks with you for in between the meals especially if you’re planning on breastfeeding. All in all, i had a really good experience and highly recommend the hospital

Waste of time! I got food posioned and waited for hours! Nobody checked me and I had to leave because another patient came and told us she was waiting for 7 hours. I mean this is an emergency, it shouldn't be like that. Aside from all these stuff there was very rude. I was fighting with pain and with the people at the same time. Not even talking about the money I paid for the taxi because I thought I can get help here. I don't know what I am gonna do if I ever have more risky situations like that. This has to be changed.

18 year old friend of mine has been hospitalized due to a tumor. because of a so called "emergency" a vacation had to be cancelled and he didn't even make it into the infirmary. during the operation they managed to injure the liver (which isn't exactly spottet on the head) and he was in a critical state. he died less than a week after the operation and the doctors had the audacity to say "have a nice evening". worst hospital ever. will make sure none of my loved one's ever go there again.

Very bad hospitality.

My girlfriend went to their E.R. It took them seven hours to accommodate us. A nurse misplaced her chart adding to the delay. I understand that there is a triage system that prioritizes severe or emergency cases but waiting for the whole day is absurd. It was especially hard for us, since we are foreigners and cannot speak fluent German. Honestly, it was a horrible experience.

Super...

I am a professional who moved here to contribute to uplift industrial activity in my own area. Heard great input from friends on Helios, about English speaking staff, better handling than long and declining German medical system. When registered my wife for birth and checkup at the last stage of pregnancy - and recently visited, the rooms are hot (making the patient more inconvenient), then we requested female doctor/nurse due to our own comfort and values, but instead when the female doctor arrived she ended up giving me lecture to understand their culture, you are in germany, even in your home country there are only Male doctors & Staff (which she doesn't know 60-70% of medical employees are female in my home country). She was straight forward denying the service if we do not agree on the male attendant. We had no other option but to say yes, however, this has been traumatic experience turned from a happy moment. As a Service provider the doctor should be able to provide a relaxing and comfortable environment. And the treatment was not something that couldn't be done alone when requested. It was a one person job, she could have do it herself, but forced to have male attendant to just hand over tissues or so. And even after that told me to expect male attendant regardless you want or not during delivery.. Service providing is the key. highly disappointed.

I could put 0 or -5 if that was possible. I guess 1 star goes to nursing personnel some of whom were nice. My mother was admitted there with stomach cancer and fluids in abdomen supposedly for immune therapy (we know it is a last resort). Doctor (Ali Nuri Hunerliturkoglu) even wasn't fully aware of the diagnosis at the admission. At putting the port for immune therapy/chemotherapy, lung was punctured leading to an infection. Biopsy results were late, hence no promised immune therapy was provided just a general, non-specific chemotherapy, which weakened the patient together with hospital-induced punctured lung and infection to the point of not being able to walk and normally function. No help at all, just prolonging of suffering. To top it off, transportation to pick her up and deliver home was not allowed to approach hospital premises and a lying patient on a rolling bed had to be transported for 10 minutes outside in the cold. Avoid if possible

I had this year three operations in Krefeld hospital.Two of them was not planned one of them was planned.Everything goes smootly.Personal are very friendly doctors also will try to explain everything till the end.Food quality also not that bad like hospital food.My plate was empty always.I had only one small minus the pillow for your head its like a carpet to clean your shoes so tin and not comfy at all 😀 Even this hospital is one hour where i live but anyway i would always choose this hospital and recommendate to others

one day I was very sick and had to go to the Emergency. They said they would not treat me. Because I had to be referred to the home doctor first. I wonder which house doctor can be reached at 4 in the morning? They didn't treat me and I wasn't even able to walk. I cried and had to go to another hospital. Besides, the staff working there were very rude. They were talking to me as if they were shouting at me. And even when I asked some questions, they wouldn't even answer me. They didn't even look at me because I was a foreigner. I do not recommend it to anyone. If I had fainted there, I think they would have referred me to a home doctor.

I visited for the second time the emergency today. The first time nobody could point out a doctor as nobody could speak even a little bit English. Today I found a kind lady in the morning reception who gave me instructions to come again at 18:00, visit the 1st floor, to see a doctor for my emergency. I did. As I arrived I said that I don't speak German. None of the assistamts there could speak. They kept my Insurance Card and I was waiting for my turn. I heard my name and a nurse gave me a cup to pee. I used google translate to ask what the cup has to do with my pain and if they have at least someone speaking a little bit English to say what my problem was. They were explaining to me in German and as I could not understand they were just rolling eyes. If you are German prepare to get some rude responses as the specific assistant was yelling to people. If you do not speak German prepare to die as the punishment for not knowing German is death. I feel very disappointed

Really shocking service - be ready to waste your time. I wonder - what would the world be like if we all had the same attitude to each other as the staff do to their patients? HORRIBLE

Awful. Patient Management is closed when it have to work. No response via phone to ask why you must pay specific amount of money and for which services. Huge respect for doctors, but management of clinic is awful and they deserve even less than 1 point out of 5.

After almost 30 hours, they still don’t know when they can perform surgery on my kidney stone. They only gave me 5 glasses of water! When I asked them about my situation and the plan, nobody answered! I’m thirsty, hungry, and in pain from the stone for more than 1 day. This is simply the worst hospital I have ever seen in my life!

Unfortunately but I have a pleasure to have surgery on pancreas cancer here. UK NHS said its noopetatable😬. The rooms 10 stars out of 5🙂, super clean, staff constantly checking on you, everything went smooth and pain free(thanks to epidural and painkillers). I have been sent home when I was ready, no complications and, 7 month out and good so far. Highly recommend, plus beautiful town which I was able to see before surgery.

The service in the " Station" is a disaster. Really really bad, the personal will barely visit or ask you if you need anything and moreover I have done their job, therefore being unable to have any meal as the baby was constantly crying...no one even asked if I need something... If I have to rate it - then I will even not put a star... just as bad as it is... No more here anymore!!! ( hopefully not reaching any hospital at all)!!!!

I’m not sure how well you think your clinic is working or how well you’re doing. However, our 6 month old has not eaten for 16 hours (3 of those hours are spend in your waiting room so far), or has eaten, but hasn’t managed to keep it inside as he has been puking, a lack of energy and a behavioral change after falling on his head. Now, like many parents, we seek the advice of a specialist. Where your clinic is unfortunately the closest one to us. We just wanted the advice of a doctor, however, we got shipped off the the emergency clinic by the receptionist. Here my issue starts. How can you call it an emergency clinic when the waiting time is over 3 hours? (3 hours and counting when writing this) When you don’t filter anyone coming in. I’m definitely not saying we’re an emergency case, neither am I stating I am a medical specialist and can judge the cases, but, from what I can see, 80% of the cases sitting in here aren’t emergency cases either. It’s just parents sitting and waiting. People sitting on the floor, people waiting outside in the rain or sitting in an idling car because you lack waiting room in an emergency clinic treated as an undersized doctors waiting room. From my point of view, this is only your issue: - either you’re understaffed in the children clinic and therefor decided to just sent everyone straight to this “emergency room”, even if it isn’t anything closely related to an emergency. Or; - you’re too small for the capabilities you’re trying to offer and hence investment is needed from your side to modernize and expand Or; - and this might be a bold one, you’re collecting insurance money by sending everyone to emergency care first and hope they get sent to the children’s clinic so you can bill twice. Which one is it?

I was there twice with my kids, the reception, emergency service were very friendly & helpful. One of kids were to stay in the hospital and the staff on the residing floor was also very helpful, my kid was also in the intensive care and we felt really in safe hands there with a super friendly and accommodating staff. A big thanks and kudos to all the team there!

I, or we, would like to thank the doctors and nurses who looked after and cared for our father and husband from the bottom of our hearts. The situation wasn't easy for us, but everyone always answered our questions openly and honestly, even if they asked the question 20 times. They stood by our side in his and our most difficult hour. The ITS2 is not a ward like any other, but people with heart work there ❤️. Thank you thank you thank you

They are really unfiendly. I am learning German because I live here but my german is not sufficient enough to book medical appointment. If you can't understand me that is okay but you don't have to be rude!

Nurses are kind, the place is clean. You must speak german at least on a minimum level and understand what they say to use the services.

I got a brain surgery in 2017 and stayed for over a week here. I felt well treated, especially by the staff of international nurses and some doctors. I got some complications that I don't know whether they came from the care I got or if I dodged a bullet (6 hours surgery). Follow ups are a pain, emails don't work, phones only, and one has to wait for months for something.l, but the system is the bigger problem. I trust the professionals here, some will even talk English to you if asked. (Sure, don't come to the emergencies if you can be treated elsewhere). The facilities look a bit better than other hospitals in town.

the worst hospital I've been to. I broke my leg and they told me to go at 7 in the morning for the operation and they left me until 8 in the evening without giving me any information, without water. Then they remembered to come and inform me. The next time I was driving with my mother, who had a bypass and her blood pressure was quite high. The doctor asks me if he is dead? does someone have to die for us to go to the hospital? Because we also pay insurance for the doctors.

This is going to be a long story about my terrible experience in the emergency service. An ambulance brought me here at 21:30 with a broken swollen ankle. Since the emergency guy brought me inside and put me in a bed, no one came to me to do the first check-up. I begged 3 "nurses" to at least bring me ice because I am dying of pain. They go and never come back. They didnt give me ice, nor pain killers, they didn't even do a first check-up on me. How professional! especially when I can see them talking to each other, laughing, talking over the phone. The level of ignorance that I saw here is unimaginable. They are lucky that I was in pain otherwise I would have called the police. So around midnight finally someone came to do xray for me. half an hour later someone came to me to explain the severity of the injury, put the cast for me and gave me the crutches. Then he told me a nurse will come to explain everything, show me how to walk with the crutches, bring me outside with a wheelchair and call me a taxi. But no one showed up. I was screaming and no one heard me. At the end, around 02:30 I had to ask a "guest" for help. Luckily he was a nice guy unlike the nurses and stuff here. He helped me to walk outside and waited with me for a taxi that I called! I am waiting to fully recover and then I will see a lawyer about this. I even called them after days to send me the xray because the doctor wants to see them and they ignored my emails and phone calls. 5 hourse in the emergency with a broken ankel. No help, no check-up, no ice, no pain killers. No one helped me to leave and they didnt even call me a taxi!!

Worst criminal violators "working" there!! Stole one of my Organs also, when i was three years Young, and many litres of blood!! Other Details, you dont really wanna know 🤢🤢🤢🤮

Ok where do I start… first of all I don’t understand the negative comments here. The doctors are very good, excellent! They are so excited when they know our mother tongue is English and they want to talk English to us! We even had today two nurses, they asked if we can stick with English, since they never get the chance to talk in English! The nurses are just so nice and welcoming! We feel so good treated from the doctors and also from the nurses, generally all staff! You need to understand this is a VERY BUSY hospital, people are coming from many kilometers away to see a specialist here! If you don’t have anything severe, don’t keep this hospital busy. Since people like us travel miles in order to come to this Zentrum! We are very happy to be treated well. Just the organization feels sometimes kind of chaotic, probably is due to the busyness of this hospital. Thank you MHH for taking great care of us! Yes the architecture and rooms feel sometimes outdated, because this hospital was built like 60 yrs ago. But who cares about that, when the care is very good! Our comments are for two clinics: Hepatologie and also Viszeralchirurgie! Can only highly recommend it!

0 humanity,0 empathy. It’s not up to anyone to work in a hospital.some are juste heartless.

Was there at 10:30 PM . They registered quick , took blood and immediately send me to the concerned department. However had to wait 3 hrs before a dr finally addressed me . Really is this how they define emergency?

A tertiary hospital with a lot to offer, successful surgeries and high tech equipments. Problem is the people working in it. It puzzles me why some staff doctors and nurses are incompetent, arrogant, rude and unfriendly.

Disaster! Avoid coming here by all means. Hours and hours waiting when there are no other patients and you are being told just to wait a little bit more! Catastrophic, the worst ever!!!!!!

Accidentally my mother is sick,she is a 3 month visitor,I called 112 , the crew came very fast ,they were very kind, professionally treated my mom and they helped me with language when we reached the hospital , the nurse, receptionist,the Dr all give professional service ,with smile in their face,I stayed almost 8 hours, they were very busy ,they receive now and then emergency sick people.i just can say ,God bless you all the time ,God give you healthy life as you help a sick people under God will.thank you very much to all Ak clinic crew ,l💕💕💕💕

I was here two weeks ago as I cut my finger by accident. It was bleeding A LOT. Dripping onto the ER floor. Nobody cared until I had a panic attack. There was at least one good nurse with empathy. She was young and had black hair. Should have known her name.. The other middle aged nurse would mock me while passing, saying sth like she (obviously me) keeps crying and crying 😒 (with this face haha). I’m sure she thought I could not understand German only by looking at my appearance. Anyway I waited for like at least four hours there. Okay, yes, I was not obviously dying and I knew that, but at least I wish I had known what was going on and all. And the ER was not busy at all. Like four patients before me, I think. When I could finally get the x ray done, the woman in the x ray room was the WORST. My tendon was 100% cut so I could not move my finger. And yet, the incompetent woman tried to force my finger straighten up so hard and it gave me a lot worse pain than the one I had before going into the x ray room. Anyway, in the end I got transferred to St. Georg’s Asklepios and got surgery for re connecting my tendon after a long waiting time. I don’t think my nerves were connected properly as I cannot feel right side of my finger very well. I’m visiting a different hand surgeon at a different praxis. If this symptom persists, I’m getting the check up outside of Germany. Just like one review I have read here, I would rather just die (lol, with a bit of exaggeration) or fly to my home country with better health service if necessary. Even Cambodia had a better hospital, where I had to visit because of anaphylaxis during my travel there.

Very friendly staff overall. I came here to get my booster shot and I was at the wrong building, the security guy showed me where I needed to go. Then at the vaccination facility, the doctors were very helpful and informative.

Do not go here. In our experience there, they did not take our pain seriously. On top of that, they made sexist comments!! I would not recommend this place to anyone for anything.

I have visited Orthopedics department 2 times, really awesome service. Could be better, little more waiting time however currently it is really good, humble staffs and polite in nature.

Negligent in their duties, they don't follow medical guidelines. Many workers are just arogant and would want you soon out of thier way rather than trying to find the cause for your ailment. It's sad they are a university who make helathcare workers of such low quality.

Context: Foreign patient/tourist Lack of signage for foreign patients is what exacerbated this horrible experience not knowing what is the correct entrance, the fact that you can't go any doctor and must go straight to the emergency reception for example (flat fee is also 200 EU which luckily was refunded by my travel insurance) 1 receptionist out of 7 was friendly, rest were horrible to an ill person despite being polite as possible 1 doctor in the emergency ward was pretty careless after dismissing me from the hospital (and was dismissive), not even providing a proper dressed bandage for my wound after removing a drip needle that was never used to give fluids (something usually done for pain or dehydration - I was expecting some for relief but none was given) A trainee had better bedside manners The doctors in the gyni section were absolutely fantastic, explaining everything, being friendly etc. However, nothing was found for the cause of my pain which was distressing and no pain relief was offered even. A traumatic experience for someone traveling alone. I hope this review helps someone in the future. Will never be traveling back to Cologne as the reception to tourists is 99% of the time cold as ice.

First , I can not comment on medical services , but the buildings and the arrangements, the wide variety of specialties and advanced equipment all are amazing. Well organized campus.

My wife gave birth there. This was the only good experience we had in hospitals. I want to give thumbs up for the best team in the world and especially to Frau Hannah. 🙏

We also experienced the worst possible care. We were there the same night, September 11, 2023, when Marcia Lorena recently posted about the inhumane treatment toward her 87 year old grandmother, who the ER refused to treat. We are witnesses to this horrible treatment/nontreatment. We also were ignored for 3 and a 1/2 hours. We believe we were ignored because we are Americans. Several wonderful German women helped us by asking in German when my husband would be seen. They helped us four times. They were appalled that no one would see us. The desk person kept telling us that we had to wait and that they did not speak English. However, they told us a female doctor spoke English and would see us soon, but never did. It was 10pm at night and no one was in the Emergency Room and they still ignored us. During the 3 and 1/2 hours, we saw lesser cases come in and get assistance, while we continued to wait. We eventually left. I can tell you this would never happen in the United States of America. In the United States, they take you and care for you, no matter what country you are from. I wish these ER hospital personnel could experience the helplessness that we felt when they ignored us, when they are sick and outside of Germany, but unfortunately, if they are traveling in the United States, they will be well taken care of. Shame on them! Also, the Hospital Northwest should receive ZERO stars, but I had to give one, to do the post.

I was in for a sleeve gastrectomy and I could not have wished for better care in the week I was there. Absolutely amazing staff!

Management needs to be improved. A lady called me to cancel my OP the day before and said I have to wait 2 months even though I did all the pre-OP exams and of course arranged my work for sick leave before 1 week of hospital stay. When I asked if I can have the surgery with the same doctor who examined me, she started to yell, HE'S NOT MY CHEF ANYMORE in German and hung up before I responded. So I had to find another hospital to have OP. I don't understand how they can throw out a patient when their own doctor strongly suggests a surgery urgently. Also, why do they have to get ANGRY at patients just by asking questions who's already suffering and feeling already miserable?

If you call them and are lucky enough that your call gets picked up, and you ask the receptionist (in german) if she speaks english, she would in a very harsh tone say "NO" and slam the phone. I think she shouldn't be working in any field where communicating with humans is required let alone humans in distress at a place like a hospital/clinic. Pathetic!

Everyone waits in ER and i was happy to do so. The attending ER doctor was amazing anf really listened despite the chaos. I was admitted to Station 5A and the nurses were lovely. The rest fo teh doctors need to grow empathy and a heart. The hygiene of the Station was filthy and blood from my Roommate was not cleaned up for several days. The Orthodox Jewish female doctor gave me a heavy antidepressant that was touted a "to help me sleep", was totally uninterested and with an air of contempt and later that evening as were the rest of the doctors there, the male nurse tried to steal my phone charging cable thinking i was unconscious from the medicine, that thankfully i vomited. To the red headed trainee nurse, thankyou for looking after me and believing me, your hunch was correct. I have since been diagnosed from a real hospital with Post Vak (Uniklinik Marburg) who laughed at the arrogance and poor attitude in the Asklepios Artztbrief. Everything that was "unaufällig" turned out to be pleural effusions, neurological damage and a blood clot that SHOULD of been discovered easily by Asklepios. SHAME ON YOU.

I was extremely sick with high fever and attendees at the help desk was so rude and even deny to let the doctor see me. Pathetic people with no humanity!!!

Unfortunately, the attitudes of almost all the staff during a recent outpatient trip to emergency were extremely regrettable. I was initially refused any painkiller for hours, despite having a broken bone. I was made to wait 7 hours, more than all the other people who had come in, not all of whom were acute cases. And I was not given a medical report on leaving, which meant I had to make a separate trip back to the hospital to insist on receiving it. I attempted to politely follow this up through normal channels but the response was excessively defensive and factually incorrect. No apology, no points acknowledged. Very disappointing indeed. All I can say is that 80-90% of the staff there were unpleasant, seemed to hate their jobs and made a difficult situation for me and others like me far worse.

Supportive, very friendly staff and fast help. Large site/area needs time to orientate and find your way. Treatment was top and newest available.

Non-professionals, there is no good communication with the patient! If you have a serious problem, it s better to look for another hospital! It takes a very long time for them to respond, and when they do, they are never clear. It seems like they want to get rid of you or respond in a way that makes you give up and look for other doctors or hospitals. Be clearer that you are medical professionals! For station mund und kiefer.

Came with toothpain on sunday,didnt wait too long cca 2 hours, doctor and nurse were very kind,spoke English,helped me with pain,so im happy i came there,just parking is pretty expensive.

The emergency department is just a disaster. Organisational chaos. As a result- hours in a waiting line.

I really hope Google will someday let me give negative score to this place. I had to wait 2 months for an appointment, only to come here and sit in the waiting room for 1.5 hours (and the appointment is for a 2 minute consultation). The level of inefficiency and incompetence is just astonishing