No, Gillis, it cannot be true! It is contrary to ethics and ownership rights! The patient is always right. “Listen to the patient! He is telling you his diagnosis!”. Furthermore, you are an owner of Swedish health care, as a voter and a taxpayer.
I know. You are a minority shareholder of Swedish health care. Nevertheless, your share
is as great as mine or that of the Prime Minister (“first servant”).
It is not worth while to scold politicians. We choose them, and have the politicians we
deserve.
You suggest that I have health privileges by my profession? Possible advantages would be
due to individual skill and discern, which are not to to be taken for granted.
A laborious thought? Let us apply a scientific mode of thinking and look at a
“contrast material”! The innkeeper is closer to the bottles and the meat pots
than the paying guest. Nevertheless, few innkeepers eat and drink healthier than their
guests.
“I have reduced my body weight 5 kilograms this spring. The trick is to follow the
standards of FDA. The key point is to start right with a right breakfast – one dry
Danish, three tubs of black coffee, and five wholemeal cigarettes!”
Many physicians themselves avoid health care as far as possible. Others upfront death by
chewing tablets with marginal protection potential and significant decrease of life
quality. Admittedly, I choose my dentist and my doctor with care, if I am able to
influence the choice.
Let us begin with the special case that the patient is a physician. The opinion of the
physicians themselves appears to be that collegues are difficult to handle and apt to slip
into wrong production lines. There is a feeling that collegues have more complications
than average patients do.
If a physician gets ill, in fact or in own fiction? A severely ill physician, like every
other person, looses all influence over the process. Family, neighbours, ambulance staff
take over. If moderately ill, the physician has time to brood, examine, make test
treatments, sometimes for better, sometimes for worse.
The relation between patient and doctor is basically the relation between user and
servant. “Everuthing is permissible for me” – but not all is beneficial.
The physician is the medical adviser, for the evaluation of the problems of the patient
and for support in the choice of handling. The present context is devoted to the primary
analyses and choices of the patient.
Our choice of context excludes the specialists corresponding to the special worker at the
production line, the specialist who thinks a thought and makes an operation 20 times a
day.
No doubt a 20-times-a-day specialist is superior to a once-a-year specialist, provided
that the problem of the patient fits the competence of the specialist.
The interplay between patient and physician is interplay between independent persons such
as Sherlock Holmes and Watson, Bertie Wooster and Jeeves. By capricious circumstances,
each of these basic roles, personae, may appear in the seat of the patient or in the chair
of the doctor.
The role of the proprietor? Since we all own and rule Swedish health care by elected
politicians and selected administrators, we are all aware of the goal – to everybody
the health care needed, as quickly and simply as possible.
As a rule of thumb, the straight line is shortest. In fact, our proprietor power is great;
we have to protect us from ourselves by strong trade unions.
Some ownership problems are complex. In the 1950-ties, I hitch-hiked 500 kilometers with a
specialist. When a crane stopped, he was called. Now he drove a fragile Volkswagen –
pyre provided by petrol in front – like a kamikaze pilot along narrow and tortuous
lanes.
The specialist worked methodically. He had listened to the history of the crane and knew
that he could cure it by merely scraping its top joint with his pocketknife.
The problem of the crane specialist was that he could not cure the crane by phone and
still bill the company of the crane as if he had come running himself. He had to protract
the process for profit.
The problem of waiting for expensive specialists was not exclusive for private
corporations in Sweden, the “bottle-neck” problem. For 30 years, the Swedish Air
Force had a technician, who flew all over the country with salary and subsistence
allowances for banging his fist on the engine of
non-starting airplanes. It was to his advantage to bang, not to tell the trick by phone.
The sum, Gillis, is that it is little difference between a physician patient and a
non-physician patient. Nevertheless, a non-physician patient may have some benefit of an
insight into the consultation as technique and process. The objective is to discern and
adjust to own limitations and external restrictions, not to get snared in administrative
or chemical rites.
Bo Norberg
Contrast literature
Veblen T. The theory of the leisure class (1899).
Berne E. Games people play (1964).
Harris T. I´m OK, you´re OK (1969).
Moxnes P. Heroes, witches, bitches and other basic roles in human interplay. In Swedish
(1995).
Updated juli 12, 2000