Swedish pragmatism

Just like almost everything in Sweden, the medical care is organized with consideration for practical and social benefits. Healthcare is divided into two categories: the basic one, with outpatient clinics (vårdcentral) as main elements, and in-patient healthcare with hospitals (including outpatient clinics also). Specialists of general medicine are working in vårdcentrals and they are equivalents of EU family doctors. They are called district doctors (distriktläkare).

 

The foundation - vårdcentral

Country is divided into 21 counties. Local government of a county (known as region, formerly landsting) manages and funds medical care. The base of the system, vårdcentral is a modern medical centre. Its core is a group of general practitioners, altogether serving for the whole district. Typically vårdcentral employs 4 to 6 doctors, 8 to 12 nurses, 2 or 3 midwives, 3 to 5 rehabilitants, 2 or 3 biomedical analysts, 1 or 2 psychotherapists, 3 or 4 medical secretaries who take care of medical documents as well as correspondence, and a manager of the centre, who does not have to be a doctor. Doctors are supported by welfare officers, psychologists, dietitians, occupational therapists.

There are consulting rooms, profiled surgeries and doctors' offices in the centre. Nurses can have their specializations as well, and also have their rooms where they have their appointments and where they can give advice on the phone. Registering for the appointment with a doctor is usually made after previous contact with a trained nurse, who performs the initial recognition of the problem and settles a date. Registering, medical documents and information exchange are conducted in the computer system. Paper documentation is limited to the minimum. Usually a doctor attends about 10 to 15 patients daily (average appointment time is 30 minutes). Every appointment is documented on recording by the doctor and afterwards typed and entered into the computer system by a secretary. The doctor signs his notes electronically.

Swedish names: distriktsläkare (district doctor – if working in vårdcentral), husläkare (house doctor), allmänläkare (general doctor) describe the specialist in family medicine (general practitioner). In Sweden patients first attend a family doctor, who is able to diagnose the problem and treat the patient. Doctors are also competent to decide if the patient needs to visit a hospital and others specialists. Medical examinations that were started in a primary care center can also be completed in hospital. After the necessary actions the patients can go back to their family doctors. Family doctors are also able to help patients with various illnesses at the same time, so that the patient doesn't have to visit various care units.

Family doctors can help patients with various issues, for example: high blood pressure, diabetes, depression, sleep disorders, asthma, stomach and joint ache, respiratory tract infections, rash etc. Patients are often able to choose their family doctor in a given care unit.

We used information from http://www.sfam.se/foreningen/s/om-allmanmedicin (2017.04.27)

Open and closed treatment

Basic health care and its centres are the base of the whole system. A patient is referred to a hospital specialist when treatment is not possible within vårdcentral. Hospital specialists hand over the responsibility for a patient to a colleague from vårdcentral after completing their task. Every hospital referral results in a reversible letter of appropriate content, usually fragments of patient's personal record often with additional commentary.

Swedish family doctor collaborates with hospitals: regional (university), county and sub-county hospitals. Usually there is one big county hospital and two to three smaller ones in a region. Patients are referred to hospital depending on their territorial affiliation. A specific group of patients can benefit from specialists’ help directly, without a referral from vårdcentral.

To sum up, Swedish counterparts of family doctor works in a system where their professional and financial position is established on quite solid foundations.

 

The author is an MD, former employee of the Family Medicine faculty in Wrocław, has the specialization degree as an internist and completed additional specialization training of Swedish general medicine. Now, due to the contract signed after a course organized by Medena Rek Poland in 2000, he works in Haga/Orebro VC. The text was written several years ago, he lives in Sweden with his wife and daughter.