It’s now 13 months that I was writing something here in my English blog and I’m wondering how fast the time is passing… In these 13 months happened so much! Now I’m sitting here, trying to concentrate on what happened and when it happened. I’m getting old… or maybe I’m getting “less young” as I use to say to my patients 🙂 .
Actually the big events in life are only few but the small things in our daily-routine are keeping us more busy. Being stressed, tired, jumping from one appointment to another…
Well, I don’t want to discuss it philosophically (although it would be interesting).
1,5 years… Well, in the beginning it was really tough to learn Swedish within 3,5 month. Most of the people here are able to speak English but the language at the street, the school, hospital, bank – let’s say everywhere – is (what a surprise! 🙂 ) Swedish. Of course… To speak Swedish after the language course was like running a marathon on two crutches. You can walk, you will reach the finish but it takes time to get there. The language course and its structure was really great. One key-factor was that after we had passed half of the course we went twice a week to the places where we would work later. That was a fantastic training! When we started to work after 3,5 month we knew already our colleagues, the place and a bit about the routines.
In january last year started to work in Rattvik, a 8000 people village, approx. 50 km to the northeast of Falun. The road to Rattvik is really nice: forrest, forrest, forrest. The road is climbing some hills, crossing small rivers and finally a great view on the Lake Siljan. My working place is something that I would describe as a “Primary Health Care Center”. We have doctors, nurses, physiotherapists, people who are doing some kind of psychotherapy (“light”) and we should also have therapist who takes care about hand- and work-related problems. I don’t know how many patients we have but people have to drive up to 60 km to reach us. Sweden is a big country with a small population, the distances are huge and it’s not rare that women have to give birth in the car. The next hospital is 50 km from our center.
We have found a wonderful appartment in Falun, the capital of Dalarna province. With around 38.000 people it has approximately the same size as Isa Town (Bahrain). The area it’s a bit smaller as Manama-City (Bahrain). The house is an old school from the beginning of the 20th century, renovated 2012, with large rooms (former classrooms). Our appartement has only one room but this one is really big! Behind the house a hill and forrest. Sometimes I see deers when I’m leaving in the morning. That’s really nice – and quiet!!! 🙂
Now, one and a half year later we’re going to leave this wonderful appartment. But not only the appartment but even Sweden. Why? Well that’s difficult to describe with few words.
The job turned out to be tough. More than I had thought. Primary Care is not just sickleaves, prescriptions for people who have a sore throat or teenagers who have these small little yellow spots in the face. The GP is overwhelmed by the whole spectrum of diseases, problems and what I would call “disturbances of sensitivities“. The GP is also somehow the “doorman”, the “gatekeeper”. He has to filter this mix of “sickness-light” (that he can treat himself), seriously sick people and clowns. Not everyone needs to meet a super-specialist. By the way: there is actually no real chance to decide as a patient to consult a cardiologist/neurologist/whatever-specialist in Sweden! In big cities it’s now possible to do that but doctors with their own clinic are very rare and almost exotic in the rest of Sweden!
The Swedish system is somehow socialistic. In public areas such as the health sector there is a poor conception of service. Of course there is nowadays also a lack of money in Sweden and the Swedish health system but globally I see two different ways of “making money” and “saving money”. Sometimes it’s the same. In most countries that I know the people who are working in the health care system try to make money. They’re making advertisments, trying to make it more comfortable for their patients (clients), doing for example more diagnostic just to rise their income even if it’s not necessary. If it is private then it’s the patient who has to pay. That’s not really fair. If it is the insurance or the state (tax) who is paying then it’s not fair either – we all are paying. BUT: the patient (and his money) is getting more attention. So if you fell in love with the idea to get a colonoscopy and you will pay cash then you will get it here and now (even without preparation 🙂 )
In Sweden: no chance without a referral letter. BUT: even with this referral letter from a GP you often have no chance! I’m not joking! The specialists in the hospitals are sending the referral letter back with a note that they don’t want/cannot take the patient. That means that I’m not getting help from the specialist there and the patient has actually the bigger problem. The doctors in the primary health care are getting more and more things to do, more and more responsibility without getting authority and respect in return.
It seems that the specialists in the hospitals are just picking what they want. And if they’re taking the patients: often they put them on the waiting list and that a patient has to wait 6 months or 1.5 years (!!!) is not rare but often!!! Some time ago many patients died because they had to wait too long time… Now they have introduced a fast track for some cancer deseases but this only works if you have good reasons to justify your referral letter. That means in fact that you have to know already the diagnose before you can send the patient. – But if it is accepted the it’s working quickly.
So all this blocking of patients, to refuse patients and to argue cost a lot of time and power. I’m feeling like an lawyer for the patient.
Another point is strengthening this feeling: the sick-leave procedure. In all countries I know the doctor has to write a short note about the diagnose and the duration of how long the patient cannot work. Then the insurance or the authority has to accept and if they’re not satisfied then they can refuse it but usually thet send their own doctors to check if the patient is able to work or not. This is another big difference to Sweden: Here I have to write a paper that is two pages long and I have to fill in several spaces. There I have to justify why the patient is not able to work. OK, so far so good. When I was writing the first sick-leaves, they came back. “You need to complete” was written there. OK. So I was writing again. And again the paper came back. This cost a lot of time and meanwhile the patient doesn’t get any money from the insurance if it is not fast enough. So I was completing again and wondering wtf I should write there. Then came one of my elderly colleagues. He was just shaking his head. “You cannot write it like that” and he was smiling. Why? I just wrote normal medical terms, international medical language! “No, that’s not possible. You have to write if you were explaining something to small children”. What??? But why? – “Because, the people who are sitting there and who are deciding if the sick-leave is accepted have no – NO- medical education usually.” Whaaaaaat???? Yes that’s true… There is one doctor in the background they could ask but they have the order to reduce the number of sick-leaves to get a better statistic and to save money. And: they’re getting points or something if they are doing a “good” job.
What kind of sick system is it? After 180 days it is extremely difficult for the patient to get money at all as I understood. Most of the people don’t need so much time but nowadays there is a growing number of chronically ill patients: back pain because of a disc, burn-out-syndrome, depression etc. There exist a pain-center in this province but there are so many people waiting for a chance that the center said that only patients that we treated in the primary health centers without any success for 6 months are accepted. At least accepted to wait for a chance. That means the patients are sick, cannot work (they are getting less money from the insurance) and we’re trying to help them. Then after 6 month we can send them but the insurance is saying “180 days – no money”. Then it is a hard fight for the patients and us as their “lawyers”. At the same time they have not even seen the pain-center from outside…
“You need to be healthy to be able to be sick”
It’s the whole package that makes me and other colleagues tired – and sick. In my center is only one specialist working full-time. He was in my Swedish course and is actually quite funny. But even he got once angry and said “I didn’t come to Sweden to be only busy with sick-leaves” (it takes sometimes 1 hour!). The center needs actually 6-7 specialists plus junior doctors like me. The other specialists are only working “sometimes”: 3 days a week or every second week, 50% and so on. One colleague repeated to ask me several time “You really, REALLY want to become a family doctor?” Now I understand why he asked me that way…
Another said “You have to expect a burn-out. I’m only working 50% because I want to avoid it”. Maybe he had it before… (?) A third one told me that he had a burn-out before and was 1.5 years sick. When he came back and tried to work 50% the insurance decided that he is also able to work the other 50%. They were offering to cut the grass on the street during this time. He said “thanks a lot” and retired.
It’s a strange system here, even more strange than in other countries. I didn’t expect that from a such highly developed country who is among the nations that are reminding other people to show humanity to others. “You need to be healthy to be able to be sick” said one retired colleague…
I have to say that these are my impressions and my experiences. There are also many people who are trying their best to make it better. I’m sure there are others who have much better experiencenses and who love to live here.
I cannot say that everything is bad but I cannot continue to work that way. I don’t want to get a burn-out and I don’t want to adopt this attitude of neglectance.
Ok, that’s all for today but I will describe little bit more the life here in on the countryside in Sweden later on…
Hope you enjoyed it!
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