– I stand for everything I have done, says GP Svein Gisle Apeland. In a decision from Nav control, it is stated that he cannot be a doctor in the same way as before. He is deprived of “the right to practice at the expense of the social security”. In other words, he is no longer allowed to call his patients sick. He believes the decision is wrong and will now warn colleagues. – I have treated most of my patients for many years. I know them. I know their medical history. That’s why I don’t always have to write down everything about their condition when I follow them up, he says. Yes, says Nav control. – Don’t have time for half a page in each journal GPs work an average of 56 hours a week. Apeland believes he does not have time to write full journals. – I am in contact with 40-60 patients daily. Then I don’t have time to write half a page in each journal, says Apeland. For 42 years, he has taken patients on sick leave for various ailments. At the end of March, there is a complete stop. For nine months. – They simply separated me half a year before I thought I was going to retire, says the 69-year-old doctor. There is a GP crisis in Norway. Over 235,000 patients are without a GP. This is shown by figures from the medical association. – So it is not easy for me to put 1,500 patients on the streets, says the doctor. Due to the shortage of GPs, he has chosen to postpone his retirement. The ban on printing sick notes applies until 26 December this year. – Five days after I turn 70, says Apeland. news has been given access to all documents in the case. Nav has gone through 15 patient records. The doctor has 1,500 patients. When Nav carries out such checks, it is often on the basis of tips. That is also the case in this case. May Snedsbøl is department director for Nav Kontroll öst. Photo: Private Each year, Nav checks between 80 and 90 tips. In addition, they have their own controls. Doctors can lose the right to register patients sick for anywhere from six months to five years. The agency looks seriously at cases where errors and deficiencies are discovered. – Nav is completely dependent on us being able to trust that the practitioner’s declaration gives the most objective and precise picture of the individual’s health situation, says May Snedsbøl. She is department director for Nav Kontroll öst. In the decision from Nav, the lack of record keeping is particularly pointed out when it comes to the follow-up of patients. – But behind these records are long conversations, says the doctor. In addition, Nav writes that they believe the doctor has issued sick notes several times without a documented basis. Too strict The Norwegian Medical Association supports that Nav carries out checks, but writes in an e-mail to news that they have seen cases in recent years where they believe Nav is too strict. Less invasive measures could have been tried to achieve the desired improvement in the doctor, they believe. Øyvind Anmarkrud is a lawyer for The Norwegian Medical Association Photo: The Norwegian Medical Association – Although doctors are responsible for good documentation and meeting deadlines, we believe that some consideration must be given to the overall picture for doctors in their hectic clinical everyday life, writes lawyer Øyvind Anmarkrud . According to Snedsbøl in Nav, they only react so strongly when there is a breach of the National Insurance Act. – When we assess the length of a possible reaction, this is done after an overall assessment of the inspection’s findings, extent of the errors, fault and degree of severity, says Snedsbøl. Right now, ten doctors have been deprived of the right to report sick. In the past year, 15 doctors have received formal warnings. They have not lost the right to report sick. Nav states that, according to the Health Personnel Act, there is a requirement for records to be written, and what these must contain. Snedsbøl says she understands that there is a GP crisis in Norway, and that time pressure can occur. – Nevertheless, the vast majority deliver what they need to Nav. We have close to 5,000 general practitioners in Norway. And most of them do a very good job. There are only a few therapists who are deprived of this right, she says. One doctor assesses Nav always uses one doctor for assessments in this type of case. The Swedish Medical Association believes that in some cases two expert doctors should be considered. – It should be avoided that experts measure the individual against a “gold standard” which in practice would be close to impossible, and in any case inappropriate, believes lawyer Øyvind Anmarkrud. Today, a specialist makes these assessments for Nav. The position is advertised publicly. Nav brings in more experts when required. – If the questions are outside our consulting supervisor’s area of expertise, other consulting doctors in Nav are connected, alternatively external ones, says Snedsbøl. GP Svein Gisle Apeland goes through the documents from Nav. Photo: Rosa Irén Villalobos / news Unnecessary sick calls? As regards Svein Gisle Apeland’s practice, Nav has checked 15 medical records from 1 June 2019 to 30 November 2022. During the period, the 15 patients have been on sick leave a total of 214 times. Nav believes there is a lack of documentation in 151 of the sick reports. 64 journals are empty. – I should probably keep a better journal at times. I realize that. But I am here first and foremost for my patients. Not for the system, says Apeland. He also believes that Nav has made its decision on a thin basis. – I have 1,500 patients. They have looked at 15 medical records, says the doctor. Large parts of the control period have been during the pandemic. It has then been possible to give sick leave without attending in person. This decision applies until June 2023. – So yes. I have called a number of patients sick over the phone. Like most other GPs, says Apeland. Nav states that a sick leave must be based on a consultation with the patient. Either in person or digitally. May Snedsbøl speaks on a general basis, but clarifies that the patient should not define their own need for sick leave per text message. – This can appear as if the patient has “ordered” sick leave without the doctor having assessed the need for it. In these cases, we consider that the doctor has not done the job assigned to him in the declaration work towards Nav, she says. In order to make such assessments, Nav obtains the patient record. news has previously written about the GP because he was tired of patients being refused health insurance due to psychiatry in the medical record. Can medicate Apeland still has the opportunity to accept its patients. He can both examine and prescribe medication. – But what are you going to do with those who need to be on sick leave? – No, I guess I’ll have to ally myself with colleagues, says Apeland. Health manager in Haugesund, Tone Berntsen Steinsvåg, has been informed of the decision. Health manager in Haugesund, Tone Berntsen Steinsvåg. Photo: Rosa Irén Villalobos / news – If sick calls are needed, Apeland can consult with other GPs. Colleagues can then print sick leave, says Steinsvåg. She thinks it is good that Nav has controls. – At the same time, everyone is fully aware of the crisis we are in the middle of, she says. Critical of releasing the records Apeland was initially critical of Nav getting access to the entire records of its patients. – It is not right that my patients should have their lives unfolded. And that without them knowing about it first, says the GP. Nav can obtain complete patient records if they have reason to believe that the practitioner’s practice is not in line with the regulations. Nav has reviewed 15 patient records over a period. Photo: Alf-Jørgen Tyssing / news – To check whether a doctor has broken the regulations, we have to look at the work the doctor has done for us. In practice, these are declarations sent to Nav about illness and impaired functioning for the doctor’s patients. The basis for these assessments must be written in the patient records, says director of Nav Kontrol, May Snedsbøl. Nav informs the patients after they have obtained the medical records. GP Apeland believes there is a breach of privacy. – I recommend my younger colleagues to write two sets of journals. One that government authorities can tap into. And one that’s somewhere with only two sets of keys. The doctor’s and the patient’s. The GP is now considering appealing the decision. He can do that within six weeks of receiving the decision on 6 March.
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GP deprived of the right to report sick by Nav – controls up to 90 doctors annually – news Rogaland – Local news, TV and radio
