Thursday, February 18, 2010


I had to call Bleak House - I mean Västmanland County Hospital - today to schedule a gynecological exam.

The first thing I noticed was telephone time: 7:00 am - 3:00 pm, Monday through Friday. While I realize some women may appreciate an opportunity to make an appointment before running out the door to work, if the trade-off is to call at 7:00 am or 3:00 pm, I opt for the latter. I think I can safely say the first thought of the morning of most women I know is not "I want to call the gynecologist." (Note: abortion services are another number!)

Second, this is the number to make an appointment for an appointment. When you call, you get a recording that asks you to leave your name and number and a promise that someone will call you "around" a designated time. (My callback was 10-15 minutes late.) If you call too late in the morning, all the callback times are booked and you have to start over the next day. This arrangement is a slight improvement over the old system when you were allowed to call only one or possibly two hours a day and you had to sit on the phone in a telephone queue, often for half an hour or more, waiting your turn. But the fundamental question is: When they decided to make the appointment system more "user-friendly," was this really the best scheme they could come up with?

When the clinic does call you back, you can request an appointment. But first you must justify your need. When I explained my problem, I was asked if it was urgent or if it could wait. If it was an urgent problem, I could get an appointment within a few days. If it was a non-urgent problem, I would have to wait about 2½ weeks. Urgent? Non-urgent? Huh?

I don't know about you, but I don't usually plan my medical problems weeks in advance. When I call to schedule an appointment, it means I'm ready to see a doctor now. If I could wait three weeks, I wouldn't be calling this day; I'd be calling three weeks from now! When I call, it means I've done my waiting for the problem or pain to go away. I'm ready to see someone today (or as soon as possible). That's why I'm calling!     

Tuesday, February 9, 2010

And so it goes

The orthopedist was supposed to call me today at 11.55 to talk about the results of an MRI on my knee that was performed two months ago. By 12.25, he still had not called. I emailed the department (it's virtually impossible to reach them by phone) and asked if he was going to call today.

Don't know if they had read the email, but ten minutes later - 40 minutes after the designated time - he called (with no apology). I said I had not had a chance to talk to anyone about the MRI, which had been done two months ago. Didn't I call and leave a message, he asked? Yes, I said, you left a message on my cell phone, which I didn't find until two days later. You asked me to call if I had questions. Well, I do! We talked, and I pried out of him some ideas about what could be wrong with my knee and some thoughts about what to do next.

In Sweden, you do your job. His job was to report my test results, not to assist with or solve my problem. It seems obvious, but I guess it's necessary to articulate that actually assisting a patient is part of a physician's job description.

Job description: physician. Blah, blah, blah. Must also attempt to solve patient's problem by talking to patient live and identifying action steps for treatment. Disdain for people automatic disqualification for this job.

The orthopedist did his job: he reported the test results. But did he attempt to help the patient?

Monday, February 8, 2010

Västmanland County Hospital update: Good news and bad news

On Saturday, I relayed the plight of a man waiting for chemotherapy at the Västmanland County Hospital. The newspaper vlt reports today that after it contacted the oncology clinic last week for Saturday's article, the clinic has since contacted the man and scheduled him for chemotherapy starting today.

The paper also contacted a county commissioner for comment on the man's long wait for treatment, but the commissioner referred the paper to the clinic head. The commissioner added that she had tried contacting the clinic head, division head, and county heath care director herself but had still not had contact with anyone. The commissioner also said, "But we're working to shorten the processes for transferring a patient from one clinic to another."

The good news, of course, is that the man is now going to be treated. The bad news is that it took intervention by the newspaper to make it happen. Regarding the commissioner's comment about making the transfer process more efficient, I say: don't hold your breath. They've been making promises like this for years.

(As Marti points out, you have to be healthy to be sick. Getting care requires a lot of persistence and energy!)

Saturday, February 6, 2010

Bleak House redux: Don’t get cancer in Västmanland!

I am sad today to relay the situation of a man awaiting treatment for colon cancer at the Västmanland County Hospital. The article appeared in today’s edition (February 6, 2010) of vlt, the regional newspaper for Västmanland.

In October 2009, the man visited his primary physician. It was determined he had blood in his stool. The doctor referred him to the Västmanland County Hospital for a colonoscopy. (Note: until recently, you could only get a colonoscopy in Sweden if you had symptoms of illness. It is used as a diagnostic not preventive test.). He was informed by mail there is a 4-6 month wait for a rectal exam. Because he was in so much pain, he contacted his primary doctor again to intervene on his behalf. Six weeks later he got a colonoscopy. He received a diagnosis of cancer on December 17.

He was then referred for chest and abdominal x-rays. On January 5, he received a stratum(?)/layer(?) x-ray. Six days later, he met a surgeon who confirmed he had a malignant tumor in his colon and that the cancer had metastasized into his liver. That same day he received chemotherapy through a vein in his neck and the surgeon hand-delivered a referral to the oncology clinic. “Everyone knew it was urgent,” the man says.

Since then, he has heard nothing from the hospital. What he does know about his cancer he has researched on the internet. Although he’s in great pain, he has received nothing for it. He takes only aspirin, which doesn’t help. When he calls the oncology unit, he is told there is a long wait for treatment and he has to just wait his turn.

The head of the oncology clinic was also interviewed in the article. She says the man will receive treatment as soon as he is admitted to the clinic. She says the waiting time, which is currently many weeks, is unusually long right now because the clinic is reorganizing its journal system. It has even had to offer night and weekend patient hours. The clinic prioritizes patients who have acute pain, she says.

“But cancer is never an active (sic) disease," she continues. "Medically speaking, it is not acute. It actually doesn’t matter if patients have to wait a few weeks or a month.” She also notes that the surgical unit, which performed the colonoscopy, should have helped the man with pain management when he was diagnosed with cancer. Only when he officially becomes a patient of the oncology clinic does the oncology clinic take care of him.

I've often worried what would happen if I got seriously ill and had to get treatment at the Västmanland County Hospital. Unfortunately, now I know.

Wednesday, February 3, 2010

Bleak House: Service at Västmanland County Hospital

In his novel Bleak House, Charles Dickens scathes the slow pace and high cost of Britain’s legal system. He may as well have been writing about administrative procedures at the Västmanland County Hospital in Västerås or Västmanland County health care in general where the message is clear: Patients, please don’t bother us. You just create problems for “the system.”

My knee gave out in June, nine months ago. I’m still waiting for a diagnosis and treatment of the problem.

Patient/appointment log to date:

June 2009
On vacation. Sudden sharp pain in knee. Wait several weeks to see if pain goes away.

August 2009
Still in pain. Try to schedule doctor appointment, but doctor on vacation. Clinic accepting only “urgent cases” since doctors on vacation, clinic understaffed. Call week or two later: get appointment for August 31.

(In Stockholm, the city closes one of two major children’s hospitals every year for month of July. All patients referred to children's hospital that is open. It was a nightmare the day I visited the hospital's emergency room a few years ago – waiting room packed, eight-hour wait, snack bar closed, toilets backed up so staff closed bathroom. All this with an ailing child and baby in tow. Real “third world.” But I digress.)

August 31, 2009
Doctor examines knee. Refers me for x-ray. Couple days later, x-ray at walk-in x-ray clinic in Västerås.

September 10, 2009
Doctor calls with x-ray results: nothing. Refers me to orthopedic clinic at central county hospital. Almost all specialists in county based at county hospital so must go there. Couple weeks later, notice in mail: have been assigned time with orthopedist on October 6.

October 6, 2009
Orthopedist finds nothing. Recommends MRI. (Knee is killing me. Walk with limp. Difficulty going up and down stairs. Cannot do routine tasks like mowing the grass.) Orthopedist gives me form to fill-in and mail so orthopedic department when know when I’ve had MRI. (Apparently hospital’s departments don’t talk to each other. Patient’s job to keep them in touch.) Told probably several weeks wait for MRI. Ask if I can get one at walk-in clinic. Not possible. Once patient is in hospital system, all services performed by hospital even if faster somewhere else. (Cost to the county, which is the payer, is the same no matter who performs service. Hospital just doesn’t want to lose the fee even if patient must wait months for service.)

Several weeks later, notice in mail: MRI scheduled for December 11 (two months since visit to orthopedist). Mail form to orthopedic department about MRI.

December 11, 2009
MRI of knee.

January 11, 2010
Letter in mail: orthopedist will call with test results on January 27!

January 27, 2010
Orthopedic clinic calls. Orthopedist home with sick kid. Doctor will not call today. When I can expect a call? When his child is better or he returns to work.

January 31, 2010 (Sunday)
Find message on cell phone. Orthopedist called January 29 (Friday) and left detailed message on cell phone. (Do like personal touch and respect for privacy by leaving medical test results as cell phone message!) Asks me to call if questions, but leaves no number.

February 1, 2010
Find contact information for the orthopedic clinic: telephone hours 07.15-15.00, Monday-Thursday. Call around noon, get recording: day’s quota of telephone times has been filled; try again later. Message doesn’t say when. Call again around 13.30. Same message. (Blog readers may recognize this problem from my quest last year to schedule a mammogram. Search “mammogram” on this blog.)

Find website for department and email address. Send message must speak with orthopedist about test results. Ask clinic to suggest several times when we can talk and I’ll confirm one. Also ask for direct telephone number so I can speak with department staff and by-pass telephone queue.

February 2, 2010
Email reply: orthopedist will call on February 16 at 15.30. “We hope this works well for you.”

No, it doesn't. Angry! Two months since MRI and still haven’t spoken with anyone about results. Send message: no can do; try again.

February 3, 2010
New message: orthopedist can talk with me on February 9 at 11.55, not sooner. (Heaven forbid he should just pick up the phone and try calling me!) Message also reaffirms only way to reach department is general number or email.

I confirm phone appointment for February 9.

How does Bleak House end? Several of the litigants in the lawsuit around which the novel revolves die before the case is settled. It’s clear this is also the hope of health care administrators and practitioners in Västmanland: Patients, please go away (or just die, for Christ's sake)! We’re too busy for sick people.