How do I know whether my doctor is any good?

I’ve read about a number of horrible medical mistakes on The Local. How can I find out whether or not my doctor has been reported for malpractice? - Dianne, Stockholm

• Swedish surgeon forgets swabs in sewn up mum (10 May 09)
• Swedish teen pregnant after implant mix-up (15 Apr 09)
• Woman's stomach removed after flawed diagnosis (4 Feb 09)

As any regular reader of The Local probably knows, doctors in Sweden have committed their fair share of medical blunders over the years.

But as a preface to answering the question of how to find out about a particular doctor’s history, it’s worth providing a bit of background on Sweden’s current medical malpractice system.

Unlike the United States’ professional liability system, for example, which usually relies on courts to settle malpractice complaints, Sweden uses a no-fault compensation system which separates the finding of fault from the process by which compensation is determined.

According to Sweden’s Lex Maria laws, hospitals and care givers are required file a report with the National Board of Health and Welfare (Socialstyrelsen) for cases of malpractice or incidents in which health workers are suspected of injuring or putting a patient at risk.

(The Lex Maria laws are named after the old Maria Hospital in Stockholm where four patients died in 1936 after being injected with disinfectant instead of anesthetic.)

The Board of Health then carries out an independent investigation into the reported case.

If it finds there is cause to believe that a doctor or nurse behaved irresponsibly and disciplinary measures ought to be considered, the agency passes the case along to the Medical Responsibility Board (Hälso- och sjukvårdens ansvarsnämnd – HSAN).

Aggrieved patients can also file their complaints directly with HSAN, which then determines the merits of the complaint, weighing testimony from the patient and doctor in question.

Doctors found at fault are issued warnings or reprimanded, but the Board’s findings have no bearing on the decision to compensate a patient for injury caused by a medical mistake.

Rather, compensation claims are handled separately by one of several patient insurance organizations.

The upshot is that doctors in Sweden are motivated to avoid mistakes, not because they fear getting sued, but because they want to maintain their professional reputation.

Neither HSAN nor Socialstyrelsen publish any central registry of which doctors have been reported or reprimanded, however.

But with a little bit of legwork, it’s actually not too difficult to find out whether your local doc has been reported or ‘prickad’ (reprimanded) by HSAN for possibly misjudging a past patient’s tumour as an inflamed tonsil.

According to Socialstyrelsen spokesperson Anna-Lena How, all one needs to do is make a phone call to the local branch of the agency and provide the name of the doctor in question.

“All of the complaints are on file and readily available,” she told The Local, cautioning however that there’s no guarantee that callers will get immediate answers.

“It all depends on the workload of the person you speak with,” she explained.

While Socialstyrelsen can tell you how many times, if any, that a particular doctor has been reported for possible negligence, you need to get in touch with HSAN in order to find out whether or not your doctor has been officially reprimanded.

All you need to do is send an email to HSAN at hsan@hsan.se with the name of the doctor (or doctors) you’d like to investigate. It’s also possible to call HSAN at 08-786 99 00 (but only between 1pm and 3pm on weekdays, which is when they have qualified staff on telephone duty to handle such inquiries).

And in keeping with so many other aspects of the Swedish healthcare system, getting an answer can take some time.

An official at HSAN said that it take up to three weeks for the agency to get back to people with answers to their inquiries, depending on the workload.

In its response, HSAN can provide information about the number and type of complaints (if any), filed against a particular doctor, as well as whether or not the cases resulted in an official reprimand.

Another, more general source for information about doctors and healthcare facilities in Sweden can be found at a website launched in 2008 called Doktorsguiden.se.

The site is a private, commercial venture which provides rankings of doctors, clinics, hospitals and county councils based on votes from patients. The site isn’t connected to any official state health agency and remains somewhat limited in scope, with rankings for only 75 doctors as of May 2009.

But awareness of the site is growing, and it does offer at least a dose of additional information for those interested in knowing just how competent or caring a particular doctor or hospital is thought to be.