Sunday, February 8, 2009


[If you enjoyed my post below "It's not just health care", you might be interested in this essay written in March 2005. For the record, my local clinic abolished telephone time in January 2008. (You can now call any time of day to make an appointment.) According to staff, the atmosphere in the waiting room occasionally got ugly as doctors got backlogged and the room filled up with patients who had dropped in during the two-hour "open clinic" each morning (no appointment necessary) thereby avoiding telephone time. The clinic has also abolished its open clinic hours.]

I was explaining a fine point of English grammar to two of my adult students when one of them suddenly jumped up and ran out the door. Stunned, I turned to her colleague to see if she knew what was going on. “She has to call her doctor,” she explained. “It’s telephone time.” "Oh," I nodded, and resumed the lesson.

You can’t claim to know anything about Sweden until you’ve experienced telephone time. It is the one (and only) hour of the day when you’re allowed to call and schedule a doctor’s appointment at your local health care center. Telephone time is usually in the morning (at my clinic, between 8 and 9 a.m.), about the time you’re leaving for work. On the given hour, with a deep sigh, you grab your phone and frantically dial your doctor’s number (they schedule their own appointments) as fast (and often) as you can to try and get into your doctor’s answering queue.

If you’re lucky (and your doctor is at the office on time), you’ll get into the queue on your first try. If you’re very lucky, your call will be answered within a couple minutes. If you’re unlucky, you could be on hold for twenty or thirty minutes, or more. And if you’re really unlucky, you could get stuck in a queue for ages only to learn from an answering machine that your doctor is on vacation (yes, this happened to me), and that you’ll have to start the whole process again after scrambling to find the name and number of another doctor with only ten minutes left until the end of telephone time. For mobility’s sake, I’ve learned to call my doctor on my cordless phone if I’m calling from home or on my cell phone if I'm in transit. (“Hello, Doctor?” I holler above the traffic as I push through crowds on my way to the office. “I have a terrible yeast infection!”)

If you think your problem doesn’t need a doctor, you can take your chances and try the district nurse (same procedure), who will promptly ask for your naitonal identity number upon taking the call. (Patients in Sweden do not have names, only national identity numbers.) With a little pleading and a lot of lying (my district nurse is appointment aversive), you can get an appointment; but more often than not, you’ll be asked to come during "open clinic" (9-11 a.m. at my clinic) and spend your morning waiting in a room filled with white-haired retirees.

If you don’t know your assigned doctor’s name and telephone number, or the clinic’s designated telephone time, you’ll have to waste a day getting that information. (Because you usually find it out after telephone time.)

Scheduling a doctor’s appointment can take days.

But at least the health care system makes no bones about its disdain for patients (aka taxpayers) unlike SJ (svenska järnverket), the administrative arm of the Swedish state railway, which is running a poster campaign harrumphing its on-time service. The poster caught my eye because the train from which I read it was late. (I commute twice a week between Mälardalen, one of Sweden’s fastest growing regions, and Stockholm.) In fact, my morning train was cancelled or delayed three times in February and two times in March. As was last night’s train, which was delayed then cancelled due to brake trouble. As I waited last night, I decided to have a chat with the conductor.

Why, I asked, have I been having so much trouble with trains lately? I thought SJ had fixed the problems with its Regina trains, a batch of trains purchased three or four years ago that had not been designed for cold weather. The fiasco led to massive delays such as the January evening three years ago when my husband’s train stalled in the middle of nowhere. A new train was called to rescue the stranded passengers, but even this train had technical problems and could travel no faster than 40 km per hour. In the end, the passengers waited in dark, chilly carriages (the train’s reserve battery eventually ran out) for the next scheduled train, which arrived an hour later.

(My favorite SJ story is the time a Regina train stalled and the passengers got out and PUSHED THE TRAIN to help it regain power. There was a photo of the incident, taken by one of the passengers with a cell phone, on the front page of our local newspaper Västmanlands läns tidning. But I digress...)

They’ve fixed them, she reassured me, but now there’s a shortage of carriages and drivers. Oh, yes. I’d read about that in the paper. SJ has ordered some new, nifty double-decker trains that are so overdue – more than a year – that SJ has stopped promising when they’ll arrive. In the meantime, SJ has refurbished and put back in action some old, rundown carriages (apparently with none to spare for unexpected problems) to make up the shortfall until the new trains arrive. [Author's update: Once they arrived, there were chronic mechanical problems with the double-deckers, which caused major delays and cancellations.]

Hmmmm, I mused. But why is there a shortage of drivers? (There has been some very nasty flu going round…) The drivers, she explained, are off getting training for the new double-deckers, and there aren’t enough other drivers to cover for them.

The Social Democratic party, which has been in power for all but nine of the last 73 years, is gearing up for elections a year from this fall. On cue, Prime Minister Göran Persson is talking about raising taxes to meet future demand for public services such as health care and rail transport. (Only in Sweden can you win an election by raising taxes.) But surprisingly enough, support for Persson (and the Social Democrats) is slipping. Call me a skeptic, but I think the Social Democrats are missing the big picture.

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