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Foreign docs' poor Swedish leading to errors

TT/David Landes · 27 Jan 2010, 11:41

Published: 27 Jan 2010 11:41 GMT+01:00

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“It’s increasingly the case that mistakes occur within the healthcare system because doctors from other countries can’t communicate adequately,” Karin Hedner, a supervisory doctor with the National Board of Health and Welfare (Socialstyrelsen) regional office in Malmö, told the Dagens Medicin newspaper.

Hedner’s comments come following revelations that an 88-year-old patient at the Malmö University Hospital in southern Sweden failed to understand the severity of a diagnosis delivered by his foreign-born doctor.

The doctor had tried to explain that the patient’s malignant melanoma ought to be removed as soon as possible.

But the patient misunderstood the diagnosis and instead went on an extended overseas vacation, the Sydsvenskan newspaper reports.

When the 88-year-old had a follow up visit three months later, the growth had become nearly 50 percent larger.

“It is our conclusion that if they had been able to communicate better, perhaps he could have got the patient to understand that it should have been operated on right away,” Hedner told Sydsvenskan.

Another official with the health board’s supervisory division, Per-Anders Sunesson, confirmed that doctors’ Swedish skills are an issue, adding that the agency has alerted the government about the matter.

“The problem is growing as we get more doctors from other countries,” Sunesson told Dagens Medicin.

When doctors come to Sweden from countries outside the European Union they must first take a specialized language test before they receive a licence to practice medicine in Sweden.

However, when a doctor from another EU country comes to Sweden, it is up to their Swedish employer to ensure that they have sufficiently strong language skills, often resulting to uneven checks on how well doctors speak and understand Swedish.

Story continues below…

The Swedish Association of Local Authorities and Regions (SALAR), whose members include the local government bodies responsible for the operation of most of the country’s healthcare facilities, has now decided to look at ways of addressing the issue.

“We’re in the process of putting together a group to look at this,” said SALAR investigator Barbro Emriksdotter to Dagens Medicin.

TT/David Landes (news@thelocal.se)

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Your comments about this article

12:18 January 27, 2010 by Audrian
Not speaking the Swedish language fluently can be a problem, but not difficult to surpass.

Swedish doctors who work in developing coutries serve without knowing a word of the local language. A local nurse helps with a translation. Foreign doctors should ask a Swedish nurse who work along with them to translate instructions to the patient, particularly when it is critical to the wellbeing of the patient.

Do not make too much out of this problem. Given time the foreign doctor can learn to speak swedish clearly and destinctly.
12:50 January 27, 2010 by krrodman
Communication between doctor and patient is difficult to begin with. Studies have shown that patients only retain about 50% of what their doctors tell them under the best of circumstances. A language barrier would make it worse. I give my patients a written set of simple and clear instructions regarding medications in addition to my verbal instructions. Nonetheless, about 25% do not get it right. It is really remarkable. In this case there is the additional problem of a very elderly patient. Communication and understanding is more difficult in the elderly.

I do not know how the Swedish system works, but I can tell you in the USA the doctor who made the diagnosis of melanoma would have made the call to the surgeon to arrange the consultation. Putting the responsibility on an 88 year old to arrange a surgical consultation guarantees failure.
13:08 January 27, 2010 by Beynch
Here's an illustrative example of Politial Correctness actually causing harm and injury to hospital patients. Which is more important here? Political Correctness and multiculturalism at all cost, or requiring complete language skills and an element of profiling(which some of you gasp at at the very though of)? It appears that both Socialstyrelsen and SALAR have fallen into the liberal trap, scaring them to their wits end. Heaven forbid they should be perceived as anything less than promoting mångkulturalism. I'd like to hear from some of you liberal serfs on this. Where does one draw the line? And please address the issue, don't dance around it.
13:11 January 27, 2010 by calebian22
Huh, proficiency in Swedish is a requirement to become an electrician in Sweden due to the dangers of miscommunication, but not a doctor? It would be funny if it wasn't so dangerous.
14:49 January 27, 2010 by rumcajs
I've been living in Czech Rep for over 4 years already and haven't been able to speak the language properly. I do misunderstand things all the time or just don't understand them at all. But even with sooooo little Czech, if I find my self in a case when it's vital that the other person to understand me correctly with no chance to mistakes... I can do it, even if I sound like a 1 y/o kid.

Was it so hard for this doctor to say something like "det är inte bra. Kirurgi snart, mycket snart. Förstår du?". Might sound horrible, but it is understandable and for sure anybody with even basic knowledge of Swedish can say it.

One day I woke up red like a Chinese flag and went to the doctors with my wife as translator. The guy said that it could be an alergy. She was pregnant at the time and I was very afraid that it was some rubella or anything dangerous for the baby. The guy said something that in English would be: "Well, it could be too. Let's see if you have fever tonite". He was Czech and my wife is Czech too, but obiously there was something wrong and it wasn't the language, but that he just didn't give a f**k.

So, Swedish, Chinese, Spanish, French, English, etc speakers.... doctors have to bloody care, which doesn't happen always lastly. And I they don't.... you have to pull it out from them.
15:13 January 27, 2010 by byke
I wonder if the 88 year olds hearing or attitude played any role in this error?
15:22 January 27, 2010 by krrodman

I do not disagree with anything that you have said. From a doctor's perspective things are a little more complex because in medicine there is always so much uncertainty, even under the best of circumstances.

Let us take our 88 year old patient as a very good example of this:

No doubt but that the cancer needed to be attended to and that, in my opinion, it is the responsibility of the doctor to make sure that the patient gets to the next level of care. It is not acceptable to say to the patient with an aggressive cancer like melanoma, in effect, do what you like.

That said, there are many approaches to her care based on how aggressive the patient wants to be. I can tell you without question that in the States the care is patient directed. That is to say, if the patient wanted aggressive surgery and chemotherapy even at 88 years old, those options would have been presented to her. I do not know if the Swedish system would spend that kind of money on an 88 year old under any circumstances. At the very least she should have palliative surgery to eliminate the primary tumor.

In truth, we do not really know the extent of the problem here. Was the doctor not able to communicate? Was the patient not able to understand? And again, in the USA the doctor would place the call to the surgeon to arrange a consultation. That way the burden of responsibility would not be on an 88 year old patient to make complex arrangements. For my own information, I would like to know how it is done in Sweden. How would our 88 year old patient find her way to a surgeon or an oncologist in order to plan for additional diagnosis and therapy?
15:31 January 27, 2010 by Per Johansson52
88 years old? He is very old and I am sure He would not be able to explain very well.

This is nasty excuse. Thousand of Swedes study aboard to become a doctor. it is not acceptable excuse that she made.

What does Swedish doctors know more than to prescribe you than 'Alvidan'?

This is the only thing they advise.
16:46 January 27, 2010 by totyis
Can anyone focus on the major underlying problem here? That is: not enough Swedes or proper Swedish speaking doctors in the medical system. We have a problem.

Then we should put the question: What can be done?

Then should we see some proposals like: encourage by all means the fulfillment of such a vital jobs by Swedes or take in foreigners that will accept to learn the language to the desired levels in a decided time period. Either way it would be solved the communication problem.
17:24 January 27, 2010 by krrodman
One way that Sweden controls medicine costs is by limiting the number of available doctors. After all, an internist can only see so many patients in a day - a surgeon can only perform so many surgeries in a day. The government controls the flow of care by strictly controlling the number of doctors trained in medical school. What happens if they get it wrong? What happens if a Swedish doctor decides to move to France? What happens if the population grows more than predicted by the government? The answer is that there is an inadequate number of doctors for the task at hand.

The solution is to hire foreign-trained doctors. What I am going to say next may seem odd since we are talking about medical care, but hiring a foreign doctor it is no different than a business hiring a temporary worker to meet an unexpected demand. It may not be ideal, but it is still necessary.

This is one of the unintended consequences of state-controlled medicine.
18:04 January 27, 2010 by Rick Methven

"This is one of the unintended consequences of state-controlled medicine."

How would it be any better if the medical system was US style private treatment?

All systems have problems from time to time. From my experience with Uk, French and Dutch medical care, I find the Swedish system very good.

This morning I went to the hospital here and had a 4 hour top to toe check-up ultrasound, the lot. Cost zilch I had one when i was 60 and now another when I hit 65. That is the good thing about stae-controlled medicine. A friend of mine in the States had a similar check-up cost him $8,000
18:09 January 27, 2010 by efm
What a stupid title, and typical stereotyping to malign foreign worker.

Of course a Swedish communicative skill is needed see a patient.

English is not my native language, but I can speak English well, albeit with an "accent".

that people know I'm not native American.

But that does not inhibit me from being a medical practitioner.

I can say you have Melanoma, it's a cancer, and we have to remove it right away!!!!

Perhaps, the patient is hard of hearing etc. Or some patient will delay treatments if they have plans. Some patients also have a "denial", no matter how you explain to them.

If it's an old guy, I will say, I want you back in two weeks, and if you don't come back, my nurse will call you. Document it and thus, it is not my fault, if he does not show up.
19:34 January 27, 2010 by browneyes10
As far as I know the doctors from outside the EU, they went through extensive langauge courses and without knowing good amount of swedish langauge, they are not allowed to practice here.

But I think, this doctor was from other country within EU, because usually they do not went through all this process.
19:57 January 27, 2010 by krrodman

Let me be clear. Medicine in the USA had enormous problems. I am not an apologist for American medicine. But our problems are different than the problems in Sweden. We do not suffer from a lack of specialists. We do not have to hire "foreign" doctors to fill positions. I was just pointing out that because medicine in Sweden is controlled by a government bureaucratic entity, it will have its share of problems as well.

And, the only way your friend could generate an $8000 bill for a routine check up and tests is if he did not have insurance. I had a similar evaluation at the end of last year and paid $24.
01:36 January 28, 2010 by travels
@Rick Methven

You have a complete check up every 5 years?

Being younger than you and with no medical problems in the USA I have a thorough medical check up every year. I have medical insurance and depending on what tests I have done it costs me no more than U$200 (when there are ultrasounds, etc), including seeing my main doctor, any needed specialists, lab works, radiology services, etc., all of it done within a week, including appointments and follow ups with all doctors including specialists.

In agreement with krrodman, the only way that your friend could pay U$ 8,000 for his check up is if he did not have medical insurance.
02:43 January 28, 2010 by Amber the Aussie
That is highly aggrivating. I have been applying for jobs in Sweden for a very long time now and not getting anywhere yet I can speak the language fluently (not bad for an Aussie) and I have the right qualifications.
14:28 January 29, 2010 by morchad
I live in Sweden, and have lived in the U.S. & France and I have to say in all 3 I received world-class medical treatment.....the U.S. being the winner I'd say......BUT only after I proved I had insurance..... I was literally dying.... in the back of the ambulance and the paramedics would not treat until I proved I had insurance....then and only the did I get absolutely superb life-saving treatment....by "foreign" doctors :-) it's the best system if you have insurance....I don't see any Americans in here without medical insurance talking about how great the medical system is.

My sisters baby was in intensive care in France for 90 days with a nurse by his side 24/7 which your regular insurance in the U.S. does not cover.... we enquired as to how much this would cost uninsured in the U.S --- $10,000 per day..... in France....FREE

I'll take the state regulated system......everyone is treated regardless
16:07 January 29, 2010 by efm
In France- FREE- C-mon, it's not free, it's paid by other people's taxes.

Morchad is right in one aspect, if you have insurance, specially private like Blue Shield and Blue Cross, US healthcare is the best.

There is no delay, service is fast, and if you are unhappy, you can have second opinion anywhere. You can choose a community hospital or a tertiary facility, and

will have the latest advanced technology.

And yes, a big percentage of US doctors are also of "foreign extraction" who are also

US trained, as well.

One secret, the other countries have not yet discovered, the US try to attract the best and brightest around the world, and include them in the system.

It's not like, you're not American and you're out, like what I read in this Swedish

14:31 January 30, 2010 by travels

I don't know about your experience in the ambulance, but I can tell you that in the US by law any Emergency Room (therefore related services like ambulances as well) have the obligation to take you, no way around it. I work in the medical field and see all the time how people without any medical insurance, even illegal residents, get treated in emergency rooms for everything form a headache to life threatening issues, including being in Intensive Care for days on end, up to months, and if they don't speak English they are even provided an interpreter so they can understand exactly what is happening to them...all for FREE - to them anyway, ends up being paid as Charity Care, ultimately by US taxpayers and the overall cost is quite high.

The issue with having medical insurance is more about check ups and treatment of chronic medical problems, but there are community clinics that are available at very low cost as well.
20:12 February 4, 2010 by simepal
It is strange that people talk about absence of translators at hospitals.

I am a foreigner and whenever I go to the hospital to see a Dr, there is a translator waiting for me. He or she accompanies me to the Dr's cabinet and the Dr explains why the translator is there.

I find this offensive that somehow the Swedish system would give me the services of an interpreter paid for by tax money and fail to do same for its own citizens. Why I say I find it offensive is that refusal to acknowledge the right of the Swedish citizen to have a translator is tantamount to my privacy as a foreigner being flouted by the presence of a well meaning third presence....

The system by trying to protect the PRIVACY rights of its citizen by denying them access to a translator renders a disservice to its own.

Make the playground level for all and every patient shall be just fine.

By the way 88 years doesnt seem like an age when an elderly should go to hospital unaccompanied. Where the hell are the relatives of this patient who am certain spent the greater part of his own life taking care of his own siblings ??
09:44 February 24, 2010 by Madem
As an EU citizen/foreigner, doctor living and working in sweden i can't but to express my frustration...

I do comprehend that it is of outmost importance that a person should master the language before even thinking of working in the medical sector, i have to admit that i struggled with swedish before i even moved to this country. point clear!

BUT, blaming errors on foreign doctors is not only a discrimination, it's unethical as well.

My son was born with a congenital heart disorder and guess what?? nobody from the swedes who examined him right after birth and during his controls at the notorious BVC has managed to diagnose a thing. It was merely myself and my husband (who is medical as well) who set the diagnosis and the poor child to our relief was operated in London. When we reported this in sweden, nearly everybody tried to convince us to keep our mouths shut (which of course we didn't).

what it all boils down to is that sweden is packed with xenophobia and blames nearly everything on foreigners. the sad thing is that swedes consider themselves progressive and openminded. WAKE UP!!!YOU ARE NOT!!!
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