Friday, April 2, 2010

The Gatekeepers of the Swedish Healthcare System

I grew up "going to the doctor". Throwing up, doctor. Fever, doctor. Bad cold, doctor. Annual physical, doctor. Left ear lobe ache, doctor.

Well no freakn' wonder we have to wait like 2 hours past our appointment times to get in to see "the doctor".

Here, it's different. Much different.

Gotta problem, any or all of the above? Call the local clinic, enter your number followed by the pound sign at the sound of the beep. "We will call you back before X time." And they do.

It's a nurse or a doctor, not sure. Describe your problem. All the symptoms. Then answer questions about said symptoms. And if it's your kid you're calling about, do your best to provide your own diagnosis. "I'm really worried here. His snot isn't quite green and more clogged than runny and he didn't even want to watch his favourite tv program this morning. He hugged me for twice as long as he normally does and I'm pretty sure his left eye is twitching. He needs antibiotics. I need to see a doctor."

And the hand goes up, so that I slam forehead-first into the virtual doorway. Access denied. The Gatekeeper has spoken. "It sounds just like a viral infection. There is no medication we can provide for this. He has to wait it out. Lots of fluids and blah-dee-blah."

"Ok, so what's the difference between a bacterial infection requiring antibiotics and a viral infection?" In other words, I can always change the symptoms to match the bad one!

Very detailed explanation ensues.

Damn it. This doctorish person of a gatekeeper has one over on me. I try a few more lame attempts at sneaking through the yellow tape but to no avail.

Wait it out. Call us back if anything changes.

Thanks. Damn.

On a serious and more objective note, this screening works quite well. Whenever I have made it past the gatekeeper (like twice), I'm kept waiting for a maximum of 10 minutes.

It's awesome.

But when explaining my conundrum to fellow Swedes, or expats who are in the know, I get the following answer: "Lie." If you're really worried, lie through your teeth.

I wonder how well this sytem of diagnosis-over-the-phone would work in North America. Heaven forbid the doctorish person was wrong. Hello Lawsuit!

"Antibiotics for everything" was the only solution in my uhmmm, day. And even though I realize that was due to paranoia and general ignorance and we are so much smarter now, it's still pretty heavily engrained in my psyche. I miss those pieces of yellow paper that confirmed everything was going to be alright.

I also miss waiting with a bunch of coughers and hackers in a too-full waiting room with years-old magazines to pass the hours and germy, used for decades kids toys. NOT.


Rebecca said...

I would consider myself lucky if I were in your shoes. lol. Nowadays even with private insurance, if you try to call your doctor's office, the "Gatekeeper" isn't a certified nurse at all, but someone in reception with a worse attitude. If you do manage to get through, it's an appointment about 2 weeks in the future because the doctor is swamped. If you're "really" worried and/or lie to bump it up - they suggest you go to the ER, where you wait for - depending on your condition -anywhere from an hour to eight.

SwedishJenn said...

Absolutely right there Rebecca. Though the Swedish systems likely has its share of issues, I feel very fortunate to live in a country where quality healthcare is provided free (though we pay through the nose in taxes for it). I didn't want to go into this issue too much as it's a sensitive one, as evidenced by the recent changes to the US system. Always interesting to see how another country "does healthcare". I could write an entire post on the healthcare system in Montenegro and it would make you shudder :-)

septembermom said...

I don't think most Americans would like this diagnosis over the phone system. It would give hypochondriacs something to do with their day. Imagine the number of calls. They would probably love the attention! We would get busy signals all the time :)

Michelle said...

I love this topic! As a person who works in both an emergency room and a walk-in clinic, I see all aspects of sick - from those having heart attacks in front of us to those who look just fine but want it validated by a doctor. I want to say that the Swedish system would be a great one - and I say that having just come off of the H1N1 crisis. How many times have I listened to symptoms and wanted to say, "Go home, take some Tylenol and sleep." The poor, miserably sick kids who were dragged in to the ER for a six hour wait when they were better off at home in bed. Countless, countless times. However, you're right, the lawsuits would be astronomical. Noone would listen to the Gatekeeper here anyway, as evidenced by our new Healthlink number. Call 811 to speak to a registered nurse for medical advice. They do and then come in anyway when they don't get the answer they were looking for. I'm not sure what the answer is, but I am grateful to live in a country with health care like ours, unlike some others I shall not name... :)

Hyacynth said...

See that's pretty much how my doctor's office works. We call, explain the problem, talk to the nurse and determine together if we need to come in. But I'm one of those people who is all GetAwayFromMeWithThoseAntibioticsNOWOrI'llGiveYOUAReasonToNeedSeriousMedicalHelp types. So I like this. But I also like being able to go in if I'm really worried. That makes me the really irritating type. Because I don't want to go in if I can get diagnosis over the phone, but I want to be able to go if I want to. Make sense?
Yeah, it doesn't to me either.

Tod said...

They're sure conservative when it comes to prescribing medicine. me though used to the system they have back home would take the flu medicine like( for a trivial cold, couldn't believe what they're doing here! it at first appeared totally weird, now though getting used to it!
think a lot of things to get used to ;P

Anonymous said...

i see your point
but lately since more and more bacterias and stuff has become resistant too the overuse of antibiotica in the world its good if we try to minimez the use since if we keep pushing it out like they did earlier in life then everything will have become resistant to antibiotics and it wont help.

i personally have survived without antibiotics for 30years