It is indeed desperate times regarding our Swedish health care system. Such desperate times requires desperate measures. Yesterday, I was on the phone with one of the project managers for WHO´s project on patients for patient safety, talking about the current state in Sweden.
I am part of a WHO-project publishing patient stories, where mine is one of five from Europe. As we spoke about the desperate situation in Swedish health care, I did not hold back. The project manager said that she was amazed this was going on in Sweden of all places! She also said she had no reason to doubt my words, and mentioned a letter she had just received. A letter written by a woman in Malmö. The letter reads as follows:
I am a Swedish citizen and I am writing to you to ask for your help, not only for myself but for all Swedish citizens.
Swedes are routinely denied health care and are now becoming victims of ever increasing discrimination practices within the health care system.
The entire healthcare system has become fundamentally hostile to the patients who seek care.
Because of what appears to be an acute lack of medical Doctors on staff, patients are now routinely turned away from both acute medical care and from the regular medical clinics called “Vårdcentraler”. The latter is responsible for the vast majority of healthcare tasks, including treating chronic illnesses. Waiting time to see a doctor in Sweden ranges from 2-3 months. To see a specialist requires at least 5 months of waiting time in most cases. This is in itself completely unacceptable in my opinion. However, an even more concerning problem is that the government has placed the MAIN responsibility for diagnosing all patients and determining their need for care, on nurses, not Doctors. The problem with this is that nurses are not qualified to diagnose patients. They lack the knowledge and the certification to make diagnosis, yet they now do so routinely, day in and day out. What is worse still is that this is done via very quick telephone calls. The nurses have this heavy responsibility and burden both in the health clinics, as well at the emergency wards.
The problems with this new practice of letting nurses make diagnosis includes:
1. In Sweden, nurses are not adequately educated to diagnose patients, only Doctors are. In fact, nurses are not even allowed to use a stethoscope, as one nurse explained to me during a visit. It seems unfair to both the patients and the nurses themselves, that they have to make diagnosis which is outside of their qualifications.
2. The nurses are pressured to make these diagnosis during very short phone conversations. As a result they barely have time to ask their patients more than one or two questions, and then they make a quick diagnosis and determine the need for care based upon this quick and non qualified diagnosis. Together with the pressure to not book in patients because there simply are no Doctors available, the answer is almost always that the nurse determines that the patient has “no need to see a Doctor”. Only in very simple cases like a broken arm or a wound that needs a stitch, can a patient expect to get the rare chance to meet with a Doctor faster than the 2-3 month wait. In all other cases patients can expect be turned away from medical care, by being put on the lengthy waiting list, due to these nurses often faulty, and ultra rapid diagnosis.
3. Diagnosis routinely appear to be wild guesses. This is both due to the fact that there are no Doctors available and the time pressure of the phone lines is heavy. However, it is also due to an even more troubling fact: There are no consequences to a nurse who makes a faulty diagnosis of a patient over the phone. The nurse can simply choose to NOT LOG THE PHONECALL at all and then it is impossible for the patient to prove that the call was made, unless the patient records all their calls to medical clinics. This is because the medical clinic can and will deny that the call ever happened, and despite the patient proving that the call was made from their own telephone records, the clinic will simply say, as they have done to me on one occasion that “the patient must have called in, ended up in a longer phone que, but never gotten to speak with a nurse.” So, on a busy day, a nurse may just say “you don’t need care.” and hang up with no consequences, and no risk of having to meet records of the phonecall having ever taken place.
Another problem in Swedish health care is that there is no impartial organisation that represents the patients. The two only organisations that overlook the healthcare system, “Patientnämnden” and “Inspektionen för Vård och Omvård” are government funded. This means that they get their salaries from the same organisation that they are supposed to criticise and overlook. This is a huge conflict of interest. As a result both organisations seem absolutely impotent. The only answer they give patients who complain is “We cannot question the nurses authority to make an assessment of the need for care.” or alternatively “contact the head of the healthcare clinic if you have any complaints.”
However, the head of the healthcare clinic has even less incentive or requirement to criticise their own organisation, or to offer medical care to any patient. Their standard anser to patients is “if you are not happy with the care you get at this healthcare clinic, feel free to go to another clinic.” This is a perfect answer from their perspective because they don’t want to take on more patients sine the waiting lines are already overwhelming. They know very well that the situation and the long waiting lines are exactly the same at all other healthcare clinics but that is in no way their problem. They are not required to give care to everyone who contacts them. So they keep referring patients to “feel free to leave”. The clinics and heads of the clinics are paid by the government and have more than enough patients to try to care for, in fact they are overwhelmed with the patient load. So, there is no risk for them to turn away patients. There are no private clinics that rely upon customer service being good, or on having happy patients. They are also fully aware that there is no organisation that oversees their clinics, and that the “Inspektionen för Vård och Omvård” and “Patientnämnden” are fully on their side.
Changing clinic in no way solves the problem for us patients when we need to see a Doctor or have any other concern or complaint on a clinic. We could spend two months calling a different healthcare clinic every day and still not get an appointment with a Doctor, and other concerns will never be adressed by changing clinic.
To summarise the actual situation at the healthcare clinics today in Sweden, going from one hostile health clinic to another equally hostile clinic is insanity for the patient in addition to completely fruitless, in the attempt to see a medical Doctor. When a patient complains about a 3 month long waiting time the answer is “then leave.” And the same scene is repeated everywhere.
At the emergency ward the problem is exactly the same but even more disturbing since most Swedish citizens would never ever go to the Emergency ward unless they urgently needed emergency care.
The emergency ward routinely refer patients to the healthcare clinics and the health care clinics routinely refer patients to either other healthcare clinics, or back to the emergency ward. The physical emergency ward will also often refuse care to patients and say that they should go to the Psych ward. The Psych ward then will refer the patient back to the emergency ward where the patient again is refused care and refered back to the regular healthcare clinics, who refer them to the Emergency ward….and to on. Meanwhile patients die, suffer and become chronically enraged.
There is simply put nowhere to complain. Nobody is on the side of the patient in Sweden today. I have spoken with the government office several times about this issue but they say that they are “working on the problem”, but will not specify in what way or what the time line for change is. In the meanwhile patients are faced with being turned away immediately or waiting for 3 months to see a Doctor. In other words, they do not have access to healthcare at all. This is why I am turning to the WHO for help.
I think that it is a human rights violation to turn away patients and to let them wait for months without seeing a medical doctor even to get a qualified diagnosis of the problem they seek care for.
Please help the people of Sweden! We urgently need healthcare as people are dying. There are in addition many news reports of women in labor having still born babies that could easily have been saved if only a medical doctor had gotten there in time.
The situation is acute and we need help from the world community.
Thank you for offering your authority and support in helping the Swedish government provide healthcare to it’s citizens.
This is the full letter. And I for one, hope the WHO take this desperate call for help seriously …