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Man died due to doc's poor Swedish skills

TT/The Local/dl · 7 Apr 2011, 10:00

Published: 07 Apr 2011 10:00 GMT+02:00

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A clinic in Värmland in western Sweden has been criticised by the National Board of Health and Welfare (Socialstyrelsen) after the man died of a heart attack just days after making two visits to clinic.

During the man's first visit to the clinic he complained of excruciating pain in his arms which was also radiating to his head and neck, the local Värmlands Folkblad reported.

The doctor diagnosed the man as suffering from muscle pain and prescribed muscle relaxers to help alleviate the ache.

The man returned the next day, this time hearing from the doctor that he should also take pain killers.

Two days later, the man was found dead at his home following a fatal heart attack, after which the case was reported to the health board.

Subsequent investigations by county health authorities as well as the health board revealed that the doctor who treated the 66-year-old had limited Swedish language skills and likely misunderstood the severity of the man's condition and the exact nature of his pain.

An EKG was never ordered and blood tests weren't performed, nor did the doctor reassess his diagnosis on the occasion of the man's second visit to the clinic.

The fact that the doctor refused to participate in a telephone interview during the investigation because he had a hard time communicating in Sweden was cited by the health board as evidence that the doctor lacked sufficiently strong Swedish language skills.

Story continues below…

Following the incident, county health authorities have promised to develop an action plan to ensure similar incidents don't occur in the future.

TT/The Local/dl (news@thelocal.se)

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Your comments about this article

10:45 April 7, 2011 by bocale1
I can hardly see here a problem of language. It sounds more a malpractice of the doctor that did not investigate too much on patient case.

Not speaking Swedish, I have met few times doctors speaking only Swedish but normally it is not a big issue to explain symptoms... Body language in such cases works normally very well
10:46 April 7, 2011 by saraswed
ok i have been to hospital couple of times with my 160kr every single time and saw doctors.i have told to take it easy and have some rest.so now i would blame the doctors for not understanding the severity.but language ???? its easy to ask someone to explain for you if you do not understand clearly.what about the nurse.
10:46 April 7, 2011 by Rishonim
Balberdash. It was his time to go, full stop. Following this logic, we can assume each time a foreign born patient die in Sweden is because the doctor treating him/her don't give the same attention to foreigners as they give to Svensson's
11:14 April 7, 2011 by Luckystrike
My mother passed on in the exact same situation in her fifties, and I assume from the same heart attack, " The silent Killer". She was also prescribed muscle relaxers and pain killers. This happened in the UK.

I would say this is more a case of a general lack of knowledge and competence regarding heart conditions amongst all GP's around the world.

The best advise I can give is that if you feel you have been misdiagnosed in a serious case as above, go to a hospital immediately. Educate yourselves and your family.
11:26 April 7, 2011 by johnny1939
I agree w/ you all this is not a language problem but a lack of medical skills on the part of this doctor!!! Even I would get it if the person had pains radiating down the arms etc such a common situation for heart attack for men. . It is harder w/ women and more easily missed by doctors. Yes, Luckystrike the hospital is the right place to go if you are suspicious of your strange pains.
11:34 April 7, 2011 by muscle
so according to them, if the international relief doctors were sent to iraq, afghanistan, japan etc... they all knew how to speak afghani, persian, japanese, arabic :S
12:13 April 7, 2011 by star10
The investigators are not language or communication experts. They are just medical doctors. So it is hard to assume that they have the authority to judge on such matters. I would have put more trust on their decision if the investigation was about the exact cause of medical failure (which they identified as heart attack). Moreover, the pain is not too complex to describe. I have met a Swedish doctor who has surprisingly very little English (which is strange as almost everybody speaks good English in Sweden). My situation was much more complex to describe but the doctor got it.
12:34 April 7, 2011 by DJECKY
I have been suffering from seriouse pains in my stomach now for 1year 7months and and nothing has been diagnosed also.does this means am going to hv stomach attack also????
12:52 April 7, 2011 by krrodman
I am a physician practicing in the USA. My wife is Swedish and I speak conversational Swedish. I get a long at dinner parties and in the community, but I am by no means fluent. Every so often, she proposes that we move to Sweden and that I practice medicine in Sweden.

My answer is always the same: It is impossible to be a good doctor if you are not 100% fluent in a language. Sure, I would be able to get the core facts straight(eg Do you have pain in your chest?). But, so much of medicine is in the nuance of the response by the patient, and in using the most subtle aspects of language to tease an answer from a patient. Countless times patients have answered "no" to a question that I have posed to them, but I understood that they really meant "yes" by their body language or the intonation in their voice. Additional questioning went on to reveal the truth.

I understand that Sweden has many physicians who are not fluent in Swedish. Frankly, I find it difficult to understand how patients are best served by doctors with whom they cannot fully communicate.
13:41 April 7, 2011 by Shibumi
krrodman- can I infer from your post that you believe that due to language issues, you yourself have a harder time providing optimal care to any of your patients who have difficulty speaking English to you? If so, is this borne out by your personal experience? Also, from what level of language difficulties would you say the care begins to deteriorate? Thanks.
13:48 April 7, 2011 by Syftfel
I don't think much commentary is necessary on this story. I'm sure we all know. Just one question though; What medical school did this "sub par" doctor graduate from? The story does not seem to address that.
14:01 April 7, 2011 by RitaPita
I agree with the large majority of the comments here.

It is not necessarily a language thing, but a malpractice. And as someone also mentioned, if the doctor did not understand, then he would have asked for a translation from another employee.

Yet ANOTHER unrelated story turned into racism.

Yes, it is alive and well in this country, and I can speak at a personal lever about racial acts (severe) towards me who has but a slight ethnic look.... and I'm CANADIAN!
14:07 April 7, 2011 by krrodman
In addition to conversational Swedish, I am near-fluent in Spanish . I can conduct a full medical interview in Spanish and I have a much deeper grasp of the language than I due of Swedish because I have years of classroom Spanish. That said, I frequently call for a translator in order to make sure that I fully grasp what the patient is trying to tell me.

I will assume that our doctor was neither lazy nor incompetent. I will also tell you that "excruciating pain in both arms" without chest pain(actually, pressure is more typical than "pain") is not a typical presentation for a heart attack. It would have taken a series of questions to determine is this pain was a "atypical angina" or something else entirely. The question I ask is simply this: Were the language skill of this doctor sufficient to ask the questions necessary to distinguish between an unusual presentation of a heart attack and something else entirely? If not, in my opinion he has no business practicing medicine in Sweden, and the system has failed this patient. And the obvious followup question: How many foreign doctors practicing in Sweden are capable of performing a full medical interview in Swedish?
14:41 April 7, 2011 by jackx123
my oh my.

it only takes a simple test to to measure the level of certain substances prevalent during/after a heart attack , which could have saved the man.

tragic that the doctor or perhaps vet didn't do it.
15:35 April 7, 2011 by Luckystrike
jackx123, you clearly dont know much about the variety and causes of heart disease.

Not defending the Doctor, but again saying this is a very common problem all over the world.

@krrodman, what pratice or hospital do you work at?
15:40 April 7, 2011 by krrodman

Yes, blood tests are available to help make the diagnosis. No, the blood tests, in and of themselves, would not have saved this man. He would have needed an emergency angioplasty and aggressive treatment with "clot busting" medications to save his life.

Approximately 90% of patients in the USA who present to emergency rooms with acute myocardial infarctions(acute ST elevation MIs) receive emergency angioplasty. It is an extraordinarily expensive service to provide the general population.

Does anyone know if that level of service is available in Sweden?
18:24 April 7, 2011 by Thompsuleme
Doctors in sweden always recomend alvadon or whatever they are called painkillers. its all they do.
18:28 April 7, 2011 by Swedesmith
I guess "Man Died of Heart Attack" would not have been as interesting a headline.
18:46 April 7, 2011 by William Sachsen-Coburg-Gotha
My dad saw his regular GP in the UK with chest pains for weeks. He was given painkillers and indigestion tablets. It was only when he saw a locum on one of his return visits that it was flagged up as a heart attack and he was rushed to hospital. Nothing to do with language, everything to do with looking for the simplest answer in the shortest possible time.
01:39 April 8, 2011 by N18h7m4r3

Are you serious? I also have undiagnosed pain in stomach for about two months now. Waiting for some more test results. Have you got any clue or relief?
02:18 April 8, 2011 by chemist007
it was his time.....now wts the use
11:43 April 9, 2011 by Jes
This mans death has nothing to do with language skills. Patients die due to doctors errors , incompetence , overwork etc etc.
14:24 April 9, 2011 by soultraveler3
Sounds like the doctor was just doing the typical thing Swedish docs do.

There are too few docs here and they're all under a lot of pressure to get patients out with minimal cost. It almost always takes multiple visits to get anything that isn't obvious sorted out. Unfortunately, this guy ran out of time.

It's doubtful that the language is the big problem here. He / she had to be at least somewhat competent or they wouldn't have hired them. Doctors work in different countries, with different languages all the time and they work with patients who speak different languages all the time.
15:50 April 9, 2011 by cogito
#9 Krrodman "It is impossible to be a good doctor if you are not 100% fluent in a language."

Yes. And even when fluent in the language there is a myriad of cultural nuances that one could misinterpret. A banal example: the French complain of "mal au foie," (liver ailment). Why do no other people suffer so much in their liver? Another oddity: in some cultures "migraine" is used to describe a garden-variety "headache."
09:27 April 10, 2011 by mikewhite
I don't see it being purely a language mismatch rather than "is the doctor operating in his native language" where he can ask further questions to clarify uncertainty that he can perceive.

If you were a non-native speaker talking to a native speaker patient, you might not be able to rephrase your questions to get the clarity needed.
10:05 April 10, 2011 by Uggla
They (the doctors) don't give a rats a** about you! They just wan't to get rid of you as fast as they can.

I do not think there is a doctor on the face of the earth that REALLY cares about a person. We are only numbers and dollar signs to them.

What about the baby that was sent home in Dalarna, the parents were told to just give the baby alvedon yet the baby died not long after from Meningitis. All they did was take it's temp and then send the parents on their way. This just happened last year.

And guess what my baby has had a fever for over two weeks now I was told to drive 45 minutes to take my baby into the clinic by the Swedish phone nurse, and you know what they did when I got there? Took my childs temp and told us to give our child Alvedon and sent us home. After the worry, the drive, the stress of not knowing we are left in the same boat that we were in before we went there. The nurse did'nt even examine my child!

Guess we should not bother them with our troubles when they are so busy with fikas, shopping, fests, and vacation!
10:58 April 10, 2011 by Jes
@Kroddman speaks with a bit of a complex. He either does not understand the subject or he is pretemding to understand it.

Of course a good doctor can treat his/ her patiets effectively even if he/ she is not fluent in the patients language . Doctors Without Boarders does not require its staff to be able to speak local languages in areaa´s where they operate.. That is why you find American medics in Darfur , Congo , or Haiti.

The producer of this article should be advised to find a story which published during 2009. This was about one very incomptent doctor who was hired by a hospital somewhere in central Sweden. That doctor`s abilty to speak several languages fluently ( including swedish) did not stop her from messing up operartion after operation.
09:24 April 11, 2011 by J. L. Belmar
It has nothing to do with language. Language was not a barrier for all the wrongdoings I went through during seven months at the Karolinska hospital. First, an operation in my left leg proved that the by-pass performed was 8 centimeter longer than needed. Then, a by-pass in my right leg proved to be 5 centimeters shorter. Another operation in my left leg and another in my right one to cut the 8 centimeters and to put the missing 5 centimeters. Infection in my left leg due to a Steptococus B behind a graft they inserted to make a link between the cutted artery. New operation to clean up the mess and a new by-pass over the recent one. This time it looks that it functions. The two doctors who performed the wrong operations, never spoke to me after their goof. So, it is not a matter of language, it is a matter of poor, really poor medical skills. As far as language, there was no problem; my wife has been my interpreter 24 hours a day, to avoid misunderstandings. My case is now with the "Socialstyrelsen". It might take months, but something must be done to avoid this type of medical errors.
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