Doctors Annette Dragland, Torkil Færø and Gunnhild Melleby write on news.no that today’s health care system is “sick”, and that doctors must enter the field earlier to “treat” lifestyle diseases before they occur. They list eight well-known pieces of advice for a healthy lifestyle, and recommend that the healthcare system spend more of its time promoting these factors to patients. Norway’s 5,000 general practitioners are all well acquainted with this advice. They are regularly used in conversation with the patient, most people visit them in several consultations daily in one form or another. GPs are a large and important part of the health service in Norway, and there is little that is “sick” in what they do. But in GPs’ professional ethics, it is central that the patient himself sets the agenda for the meetings. The doctor has an obligation to meet the problem raised by the patient, and to do what he can to find the best possible solution to this. In many situations, it is completely natural to enter preventive counseling. Preventing illness is important, but it will be the case throughout our lifetime that people will get sick, regardless of how much effort the GP or the individual has made regarding lifestyle. Disease, ailments and suffering strike randomly and unfairly. Preventing at an individual level is something other than preventive public health measures for the population. The GP must still prioritize doing what is most important to the individual. The international campaign “Wise choices” points out that most is not always best, and that well-intentioned medical measures can have greater side effects than what they are supposed to prevent. This is therefore also about prioritization, but more about wise health services than about budget kroner. Pressing on patients a checklist of preventive measures for all contact, regardless of the patient’s wishes, appears to be most in line with the paternalistic tradition that prevailed 100 years ago. The effect of such strategies is poorly documented, and that is not how people work today. Nevertheless, the GP often has a wary eye towards the “golden moment” when the patient wants to talk about measures that can make life better, now and in the future. We agree with all eight councils, and agree that they should be as well known as possible among the population. But we do not believe that the healthcare system, with or without today’s time pressure, is best suited to promote this in individual conversations. We are sure that this is done as best as possible at population level, through government information campaigns and the right social measures. The sustainability of our joint health service is under threat and if we are to succeed in solving the tasks we have to help people with, we must prioritize correctly. Prevention where possible and useful is a very important task, but we do not have a sick healthcare system even if not all tasks are taken into the GP’s office.
ttn-69
The GP delivers – Statement
