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.
Wednesday, February 3, 2010
Wednesday, January 20, 2010
Tacos, anyone?
About two years ago, two teenage boys from Italy stayed with us for about five days as part of a student exchange through my daughter’s school.
This week, we’re hosting two teenage boys from Portugal as part of the same project.
With the Italians, I made tacos for dinner one night: easy-to-cook and conveniently serve a group. Although the poor Italians were stunned and hardly ate a thing, I thought I’d try it again anyway with the Portuguese boys.
But alas, when we told them we were having tacos for dinner, they asked what “tacos” are. When we pointed to pictures of meat-filled wraps on the tortilla package and cornmeal shells on the taco box, there were no signs of recognition. Nonetheless, we took them through the ritual of stuffing a tortilla, and restrained our amusement as they first tried to cut the wraps with a knife and fork (which caused the wraps to flop open, bringing our guests back to square one) then follow our example of picking them up and eating them rolled (but neglected to hold the bottom closed whereby all the filling slid out onto the plate). They ate one each but declined seconds.
What astonishes me is that even in Sweden, tacos and tortillas are, today, common, everyday food. Any Swede under 60 can handle a taco. So is Sweden preternatural in its culinary tastes? Or is Continental Europe gastronomically chauvinistic?
Teenagers who’ve never seen a taco? Who’d have thought!
This week, we’re hosting two teenage boys from Portugal as part of the same project.
With the Italians, I made tacos for dinner one night: easy-to-cook and conveniently serve a group. Although the poor Italians were stunned and hardly ate a thing, I thought I’d try it again anyway with the Portuguese boys.
But alas, when we told them we were having tacos for dinner, they asked what “tacos” are. When we pointed to pictures of meat-filled wraps on the tortilla package and cornmeal shells on the taco box, there were no signs of recognition. Nonetheless, we took them through the ritual of stuffing a tortilla, and restrained our amusement as they first tried to cut the wraps with a knife and fork (which caused the wraps to flop open, bringing our guests back to square one) then follow our example of picking them up and eating them rolled (but neglected to hold the bottom closed whereby all the filling slid out onto the plate). They ate one each but declined seconds.
What astonishes me is that even in Sweden, tacos and tortillas are, today, common, everyday food. Any Swede under 60 can handle a taco. So is Sweden preternatural in its culinary tastes? Or is Continental Europe gastronomically chauvinistic?
Teenagers who’ve never seen a taco? Who’d have thought!
Friday, January 8, 2010
Time to raise Jan Forsberg's salary!
I read recently that Jan Forsberg’s salary has increased something like 60% over the last five years. (Jan Forsberg is the CEO of SJ - svenska järnverket - Sweden’s rail transport company.) Yet trains in our area, Mälardalen, run as poorly as ever.
As I thought about this paradox, I realized we’ve been looking at the problem of CEO salaries and company performance all wrong.
It’s common wisdom that poorly paid workers, or people who feel underpaid, care less about their work than those who believe their financial compensation is commensurate with their efforts.
It appears that Forsberg feels undervalued. The trains in our area are chronically late, when they show up at all. And the least bit of cold weather brings the system to near collapse. As I see it, poor train service is indicative of Forsberg’s job dissatisfaction and that SJ is not paying him enough.
The trick is to get Forsberg to care about his work. This means his salary should not be linked to performance (i.e. the better the trains run, the more he earns). He should instead be paid what he thinks he's worth to motivate him and to keep him happy.
We must get Forsberg to care about his job. That’s why whenever there’s a problem with train service, I say it’s time to raise Forsberg’s salary! Only when he truly feels valued will we see better train service in Sweden.
As I thought about this paradox, I realized we’ve been looking at the problem of CEO salaries and company performance all wrong.
It’s common wisdom that poorly paid workers, or people who feel underpaid, care less about their work than those who believe their financial compensation is commensurate with their efforts.
It appears that Forsberg feels undervalued. The trains in our area are chronically late, when they show up at all. And the least bit of cold weather brings the system to near collapse. As I see it, poor train service is indicative of Forsberg’s job dissatisfaction and that SJ is not paying him enough.
The trick is to get Forsberg to care about his work. This means his salary should not be linked to performance (i.e. the better the trains run, the more he earns). He should instead be paid what he thinks he's worth to motivate him and to keep him happy.
We must get Forsberg to care about his job. That’s why whenever there’s a problem with train service, I say it’s time to raise Forsberg’s salary! Only when he truly feels valued will we see better train service in Sweden.
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