Monday, July 18, 2011

More health care fun in Västmanland (and nationally)

I have Lyme disease/borrelia so I went to the doctor for an antibiotic. Because I’m allergic to penicillin, the doctor prescribed something else. That’s when a new round of Swedish health care fun and games began.

I decided to pick up the prescription in the afternoon when I was town. When I arrived at the pharmacy, the pharmacist checked her computer: “Hmmm…we don’t have that medication in stock. That’s funny because we usually do. If you hurry, you can check with the pharmacy down the street before it closes.”

I ran to the second pharmacy. That pharmacist checked her computer: “Hmmm…that medication is not available. It only comes in quantities of 100 tablets and must be ordered. I suggest you call Health Care Information (Sjukvårdsrådgivningen) for advice.” It was now after 5:00 p.m. on a Friday, and my clinic was closed for the weekend.

When I got home, I called Health Care Information for Västmanland County where we live. They recommended a new doctor appointment to get a new prescription. But when they heard the name of the medication, they checked their computer and said that it actually should be available – I just had to find a pharmacy that had it in stock, which meant I would have to systematically call all pharmacies in the area.

The next morning, my husband double-checked this information. (I was too frustrated to make any calls myself.) He called Apotek Information (Apoteksupplysningen), the only pharmacy chain with weekend phone service. They told him the medication was not available and that I needed a new prescription. They also told him the medication has not been available in tablet form for many months and that information provided by Health Care Information is often not up-to-date.

He then called Health Care Information again, this time in Sörmland, a county adjacent to Västmanland with which Västmanland has begun cooperating on health care and whose clinics are geographically closer to us, to schedule a doctor appointment at the after-hours clinic. (You cannot schedule an appointment at the after-hours clinic without going through Health Care Information.) Health Care Information called the doctor on duty at the clinic to see if we could get a new prescription. The doctor at first agreed to write one but then declined because she could not access my health care record: Sörmland’s computer system is not compatible with that of Västmanland. They then suggested we contact Health Care Information in Västmanland. (No one tried calling the original prescribing doctor at home on a Saturday to get a new prescription even though the doctor has a publicly listed home number and, I assume, a number on record with Health Care Information for “emergency” situations.)

So my husband called Heath Care Information in Västmanland again to see if I could get another prescription. But we learned that because our local clinic is privately administered, patient records are not available to publicly administered clinics and hospitals. (What happens if I have to go to the county hospital emergency room when my clinic is closed?)  They said a doctor might write a prescription without seeing me, but they couldn’t promise anything. The doctor on duty would check the phone log at midday so we wouldn’t know before then. But it was not likely the doctor would prescribe anything, in which case the earliest appointment would probably be some time in the afternoon. Fed up with the situation, we tried ourselves to call the prescribing doctor at home, but there was no answer.

After literally hours of phone calls, we were back at square one so we made an appointment for late morning at the clinic in Sörmland. (By the way, the after-hours patient co-payment is about twice that of the regular clinic. The after-hours doctor also told me that not counting the medication we had been trying to get, and which, apparently is unavailable, there’s only one antibiotic available in Sweden for people allergic to penicillin.)

The upshot? After a number of recent national and county health care reforms, more medications are available, but they’re not. Counties cooperate, but they don’t. Patient information is shared, but it isn’t, even within the same county. And the classic health care adage still applies: don’t get sick at night or on weekends. Plan your illness for Monday through Friday, preferably between 9:00 a.m. and 5:00 p.m.

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