I am a senior physician in a surgical subject at a large hospital. At a surgical outpatient clinic, my job is to assess whether it is likely that you will get significantly better health from an operation. Unfortunately, many patients have to wait a long time to get an appointment. Then it is quite unnecessary for patients to come who do not want to be operated on, but who just “want to talk to a specialist”. During a day at the outpatient clinic, I often end up applying for two or three patients for surgery. The other 12 receive one-to-one public information about the condition. There is information on contacting a physiotherapist for exercise guidance and advice on how the shoes should be. That’s nice, and hopefully useful for the patient. But when the capacity is limited, one wonders whether the Health Personnel Commission had not pulled its hair out a little at the use of resources by a surgeon with six years of medical studies and at least the same length of specialist training. Many people are referred after they have first had an MRI examination of the part of the body that is bothersome. Occasionally, MRI is directly unsuitable. So then we sit there, with an MRI that we don’t need and that is resource-intensive both in terms of time and personnel, and ask for a good old-fashioned X-ray that is literally done in a flash. An MRI description can frighten the water of both layman and scholar. “If you’re old and have wrinkles on the outside, you probably have wrinkles on the inside too,” a wise man once said. On MRI you can see all the wrinkles on the inside. Something as simple as wiggling the foot today has to be handled in a complicated way. Before we limped around until it was good again. Now we take an MRI, are horrified by the answer and persuade the GP to refer us to the hospital. We as doctors must stop referring to examinations just to be on the safe side, because one thing leads to another, etc. Patients must be offered good quality information, which is available to more than one person at a time. Almost every day that I review referrals, patients turn up who have initially been investigated for something completely different. Conditions that the patient was blissfully unaware of until now, and which you very rarely need to do anything about. In order to make time for those who need health care here and now, we can certainly reduce some of the checks. Is it wrong to think that we must more often give patients the least resource-demanding treatment? Radiologists I work with think ultrasound of the musculoskeletal system can be difficult. An ultrasound machine has now been purchased for every knouse that has a doctor or a physiotherapist. Of course, they also find this difficult and refer to hospital when they have seen something they did not understand. Sometimes they think they have understood what they have seen and fail to point out something that should have been pointed out. Fancy equipment does not necessarily make for a healthier population. If you are admitted to a hospital, a standard package of blood samples will automatically be taken. What we will use all the blood samples for is not always as clear. What is clear is that health personnel sit in the laboratory and spend a lot of time and effort analyzing all these samples. If something lights up red for “deviant”, we order a new package the next day. “Aberrant” samples are quite common, and something we all have from time to time, without it meaning much. But “red” test results often lead to the patient being referred around the system. We are afraid of making mistakes and hope others can share in the burden. It’s called defensive medicine, and it’s expensive. Most people who live in nursing homes have a complex illness picture, and for many, life is nearing its end. With enough medication to replace an entire meal, the elderly are transported by ambulance between nursing homes and hospitals. Life-prolonging medicines and emergency admissions have become easier to choose than to make a decision that relief and quality of life should be prioritized in the time one has left. In the hospitals, we refer to a “Prioritization guide”. Here are guidelines for who is entitled to public health care and within what time limit. Almost ten years ago, the Norwegian Directorate of Health had to send home representatives for the various hospital specialties. They had been assigned to evaluate rights and deadlines for their subjects. At the forefront, all the various specialties felt that “their” conditions were most important and should have the shortest deadline. I believe that the same professional communities today are sufficiently aware of the realities of long waiting lists, full hospitals and recruitment challenges that the outcome can be significantly more constructive today. If you also get good information for the GPs and for the patients, it can be very useful. “We don’t have the capacity to run talk therapy for people with diffuse complaints in their feet,” sighed a good surgeon colleague. Like it or not, she is absolutely right. We as professionals must be involved in the priorities and we must also dare to look at ourselves in the mirror with a critical eye in order to be sure that what we are doing improves the health of the population on the other side.
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Everything cannot be checked – Speech
