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HEALTH

Getting fit in fitful times

Financial markets implode, the flow of regular work slows to a trickle, and the only thing expanding is his waistline. Roger Choate explains how he unexpectedly came to wave his wilting wallet in the direction of a personal trainer.

Getting fit in fitful times

Summer 2008, and I knew something was wrong while driving past overbuilt exurbs in central California. Spanking new whitewashed homes stretched across inland valleys. “And where,” I asked my all-knowing brother, “and where do folks get the money for this?”

“They don’t have any dough. All they got is sub-prime credit,” he said.

Two months later Lehman Brothers collapsed, and the financial implosion rocked the planet. The outlook seemed grim, and even in snug Sweden, where I happen to live. A couple of international clients who engaged me as “communications consultant” moved into four-day weeks – and it got worse.

It was clear that 2009 would not be my best financial showing. After some sleepless nights, I could think of only one psychological escape hatch:

Shop! Spend big money on something!

For instance: How about a personal trainer at one of the nation’s gym chains like WorldClass or SATS? For 66 one-hour sessions at around 27,000 kronor ($4,000) they would hopefully remould my sagging self far faster than anything the finance minister could do for the stalled economy.

Do it yourself?

But hold on. I hear somebody asking: “Why can’t you train on your own?”

The sad truth is this. For two years I had dealt halfheartedly with sundry fitness machines at SATS in Kista near Stockholm, with no discernible results. Clearly the will power was lacking to push myself far beyond the physical comfort level: That is probably the only way to realistically improve overall fitness.

A qualified instructor was needed to egg me on. And SATS Kista had more than enough personal trainers on tap. I chose 22-year-old Christer Baskin, because I’d seen him working out with other wannabes. They looked pretty happy.

Moments of truth

American celebrity trainer Scott White suggests that a proper assessment is essential to the personal training process. In my own case, Christer Baskin posed pertinent questions at our initial meeting in his office. He first asked me about my own goals. At age 67 and at 83 kg (182 lbs), weight reduction topped my list, closely followed by vanity urges like “looking better” while feeling sufficiently fit to face the cruel, cruel world.

A couple of days later we met for our first workout when various measurements were taken. The crucial Body Mass Index (BMI), for instance, indicated excessive fat, placing me in a risk zone: a guy who might be more prone to unpleasantries like a heart attack.

Christer settled on “core” training similar to army workouts. Such as running back and forth across the gym like an idiot, swiftly followed by stair-steppers on a pallet and then shadow boxing. The focus was to get my weight down while strengthening back muscles to improve posture.

Like a farm animal, I panted through thrice-weekly sessions with Christer who pushed me far beyond anything I considered vaguely reasonable. “Kom igen, kom igen!” (Keep at it!) was his stock phrase as I struggled to lift a barbell for the third time. And as the months rolled by, he incorporated an astonishing range of exercises: such as weight training, free weights, Swiss balls, kettle balls, yoga-like movements and even a few special exercises that he tailored on the spot. We seldom used machines.

Training or diet?

Along the way, Christer discussed diet: “What sort of breakfast are you giving yourself?” The question was pertinent. Time magazine had run a cover story explaining why exercise won’t make you thin (See link below). Exercising is great, said Time, but dieting is the key.

But two months into training my weight had dropped from 83 kg (182 lbs) to 77 kg (169 lbs) without any change of diet. The BMI fat index moved dramatically downwards. How did all that happen? “Cardiovascular training!” explained Jonas Lissjanis, who manages SATS Personal Trainer programs in Sweden. “We do advise clients to look into their diets, and we’ll help. But we tend to focus on cardio training to activate more muscles in your body. So that you’ll burn more energy.”

Despite the welcome weight loss, overall progress was slow. A 25-year-old doing my programme would be preening finely-toned muscles by now. But (sadly) muscular development does take longer for older folk. So I decided to complement the three times weekly sessions with Christer by jogging twice a week with an experienced marathon runner, Erik Schenkel. He records my modest progress in complicated charts to help keep me motivated.

And encouragement I still need. It had finally dawned on me that genuine physical development would have to be a daily undertaking, in one way or other. My wife helpfully suggested additional household chores to keep me tip-top. “For starters, how about finally moving those heavy boxes into the attic?”

Who needs a PT?

Personal Trainers aren’t for everybody. At the same time, there are right and wrong ways to foster fitness. Licensed PTs know the rules of the game. You and I may not.

Strenuous and consistent training evidently has a long-term benefit. Uppsala University conducted a study showing that a control group of men under age 35 who then trained strenuously for several years could reasonably expect to add perhaps two additional years to their life spans.

Some of my own reasons were more immediate and perhaps vain. One year after I started training with the competent Christer, I had the annual dental checkup. The dentist said afterwards: “Your teeth look fine.” Then he added: “I think you’re looking good, too!

Roger Choate is a communications consultant for Swedish companies. In earlier incarnations he worked with The Associated Press, Reuters and The Times (London).

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HEALTH

EXPLAINED: What to do if you face a long wait for healthcare in Sweden

Sweden theoretically has a "healthcare guarantee" limiting your wait to see a GP to three days, and to see a consultant to three months. The reality is somewhat different. Here's what you can do if you face a long wait.

EXPLAINED: What to do if you face a long wait for healthcare in Sweden

What is Sweden’s ‘healthcare guarantee’? 

Sweden’s “National Guaranteed Access to Healthcare” or vårdgaranti, is a right to care, protected by law, that has applied in Sweden since 2005. You can see the latest version of the relevant laws here and here. Here is a summary of the guarantee on the website of the Swedish Association of Local Authorities and Regions (SKR).

Under the system, all patients are guaranteed:

  • contact with a primary care centre by phone, in-person, or by video-link on the day they seek care 
  • an appointment with a doctor, nurse, physio, or psychotherapist within three days of seeking help 
  • an appointment with a specialist doctor or consultant within 90 days of seeking help 
  • treatment or operation within 90 days, if the specialist considers this necessary 

Does the guarantee mean I have a right to treatment? 

No. If the doctor at the primary care centre, after examining you and questioning you, decides that there is no reason to refer you to a specialist doctor, they do not need to do so. 

Similarly, if the specialist doctor, after examining you, decides that no treatment is necessary, then your case is considered completed.  

Can the waiting times to see a specialist or to get treatment be longer than 90 days? 

Absolutely. In fact, they very often are. 

According to the Swedish Association of Local Authorities and Regions (SKR), in February, 32 percent of patients had been waiting 90 days or more to see a specialist, and 43 percent of those who had seen a specialist had been waiting for treatment for more than 90 days.  

The situation in primary care was a little better, with 80 percent of those seeking care in contact with their primary care centre on the same day, and 83 percent having their case assessed by a doctor or nurse within three days. 

In addition, if you agree with your specialist doctor that you are willing to wait longer for an operation, then that wait doesn’t get counted in the statistics. 

So what can I do if I’ve been waiting longer than the guaranteed time? 

In reality, it’s actually less a guarantee than a target.

In primary care, there is no way for individual patients to complain that they have had to wait too long to see a doctor or nurse, or to cut their waiting times by citing the guarantee. 

“There’s no system for enforcing that guarantee,” says Emma Spak, the primary care doctor who doubles as section chief for SKR’s healthcare division. 

It would make no sense to set up a complaints line for those who have had to wait too long for phone contact with their primary care centre, she points out, when they could instead talk to patients seeking a primary care appointment in the first place. 

“It’s more of an incentive system for the regions,” she explains.

Every primary care unit and every region reports their waiting times to the national waiting time register, and then as part of the access agreement between SKR and the government, the regional health authorities receive a bonus if they meet their waiting times goal, or if they improve their waiting times. “That’s one way of sort of enforcing this guarantee,” she says. 

When it comes to specialist treatment, though, patients do have the right to demand to be examined or treated by an alternative specialist or hospital if they’ve had to wait longer than 90 days.

If your primary care centre issues you a referral to a specialist, and the specialist cannot then offer you an appointment within 90 days, the specialist, at the same time as offering you a later appointment, will often put you in contact with a unit at the regional health authority who will offer to find you an alternative specialist, either within the region or elsewhere in Sweden. 

The regional health authority will then have to reimburse any extra travel or hotel costs incurred by the patient.  

Similarly, if after examining you, a specialist cannot offer you treatment within 90 days, they will normally put you in contact with the same unit. 

Some regions have a phone line for people who have been waiting too long, or else you can contact your specialist or primary care centre and ask for information on seeking an alternative specialist. 

What happens if I don’t want to travel to see a specialist or get treatment? 

If your regional health authority offers you an alternative specialist, either within your region or in another region, so that you can get treated within the 90 day period, and you are unwilling to travel, then you lose your rights under the guarantee. . 

“If you’re in Gothenburg, and they say you have to go to Stockholm to get your treatment, and you say, ‘no, I want to go here, then then you’ve sort of forfeited your right, and you have to take what’s on offer,” Spak says. 

What happens if I agree with my specialist to wait longer? 

If your specialist says that they can treat you in four months, but also offers you treatment elsewhere within the guaranteed 90 days, and you choose to be treated by your specialist, then that counts as a patient choice, which will not then be counted in the statistics. 

“The specialist might say, ‘I don’t think you will get any worse for waiting two months extra, and if you wait five months, then I can make sure that you get your surgery done here, and we can make sure that you get all the aftercare and everything here as well,” Spak says. 

But these patient decisions are also counted in the statistics, and if a region sees a sharp rise in patients choosing to wait, SKR will tend to investigate. 

“If some region all of a sudden has a lot of patients choosing a longer waiting time, then we will call them and ask what’s going on here, because patients don’t tend to want to wait extra,” Spak says.  

Can I get financial compensation if I’ve been waiting too long? 

No. 

What other ways are there of speeding up the wait for treatment? 

Don’t underplay your symptoms

When drawing up their timetable for treatment and assessment, specialists will tend to give different patients different wait times depending on the urgency of their case.

For this reason, it’s important not to underplay your symptoms when visiting a primary care doctor, as they will tend to include a few lines on the urgency of your case when they write their referral. 

Stress your flexibility 

If you are unemployed, a student, retired, or have a very flexible job, it is worth telling your primary care doctor about this, because they may write in your referral that you are able to make appointments at very short notice. The specialist may then put you on their list of people to ring if one of their patients cancels. 

“Sometimes I write in my referrals that this patient could easily come at short notice, so please put the patient on the list for people you can call if there’s a time slot available,” Spak says. 

If you haven’t told your primary care doctor this, it’s not too late. You can ring the specialist yourself and tell their receptionist that you are very flexible, and ask to be put on the back-up list. This is particularly useful if you’re waiting for a scan, but you could also potentially work even if you’re waiting for heart surgery or a hip replacement. 

“If they’ve accepted you as a patient, and they’ve made sure that you fulfil the criteria for having that scan or whatever, then you can call them and say, ‘I have a really flexible job, I can come anytime if you have a gap,'” Spak says.

“A lot of people do that, because they can have [back-up] waiting lists. If you tell them ‘I work around the corner and I only need 15 minutes to be there’, then they might call you if someone doesn’t show up.” 

Ring up your specialist 

The queue system tends to be quite ad hoc, with no strict rules over who should be treated first, so it is often possible to reduce your wait by ringing up your specialist a few times a month, just to bring your case to their attention. Sometimes the receptionist will remember a slot that has just come free and bring forward your treatment while you are still on the telephone. 

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