Sjukvårdrådgivning and general practice

A word like sjukvårdrådgivning is rather inaccessible to the average English speaker. Like many Swedish words it is a combination word, made up of sjukvård, which means sickness care, råd, which means advice, and givning, which means giving. So this long word refers to giving advice about sickness. The word telefonrådgivning is also used commonly, and obviously means the giving of advice over the telephone.

A major primary health care initiative in Sweden in recent years is this telephone advice about illness. It is meant to take the pressure off health care centres, or vårdcentrals, which are the Swedish equivalent to general practices in the Australian or British systems. The idea is that when a person is sick they ring the call centre for advice, rather than their local health centre. The phones are manned by specially trained nurses who are able to give basic advice about self care, as well as advise if a patient needs to be seen by a doctor or not. In the latter case the nurse is able to make a booking for the patient at their local vårdcentral, or at an after hours medical centre. These nurses are highly skilled and very competent, but to the patient they are faceless and impersonal.

The basic assumption underlying this system is that many patients who see doctors do not need to. They have self-limiting illnesses that need no specific treatment but simply explanation and reassurance. This explanation and reassurance was once seen as the duty of the family doctor, and in the giving and receiving a relationship of trust and respect was developed. However, because no prescription needs to be written, a doctor is not legally required. Therefore someone else can do the job.

The problem with such a system is that the relationship between doctors and patients suffers, in that it reduces the amount of contact the doctor has with patients. This is not an issue in the so called “organ specialties”, like cardiology or surgery, where the doctor’s main concern is the disease. But in general practice, where the focus is on the person rather than the disease, it eats away at the core of the specialty: the doctor-patient relationship. At the end of an average year a person may have had multiple contacts with the health care professions, but the so called “family doctor” is completely unaware of any of them.

So what began as a way of dealing with a lack of doctors is in my opinion contributing to the gradual decline of general practice or family medicine as it is ideally imagined to be. There is a decline in satisfaction for doctors which may well lead to a loss of interest in general practice as a profession, and a worsening lack of doctors. Patients, for their part, soon see that they have no family doctor as such, but their contact is with an impersonal and faceless source of information. As in so many areas of modern life, information rather than relationship is seen as the answer to problems.

I personally believe that relationship is more important than information. But an even higher ideal is reliable information in the context of relationship. That is the core competence of general practice. It is the goal of specialty training in general practice in Sweden. But that is what is at risk of disappearing if we continue down the path we are going.

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