I have been asked to be interim Chief Editor for the European Journal of General Practice while the WONCA society is interviewing for a new, permanent Chief Editor. The process has taken a bit longer than expected. For eight years I was Chief Editor of the Scandinavian Journal of Primary Health Care and at the same time head of our department of primary health care. Do modern times mean that nobody has time for things like being Chief Editor of a medical journal? Are we busier today? It seems as if our younger colleagues have less time than we had. Even school-children are more stressed today according to what has recently been reported. We who live in the Western countries are richer and richer, but seem at the same time to be busier and busier, and maybe also unhappier.
Some of us are privileged, however, for example doctors. Just the privilege of being ‘needed’ even at the age of almost 75 can make a person happy, at least me. I can still go on with my research. Just a few days ago I was asked to work as GP some days in May. At this rather high age I was even asked to be interim Chief Editor of a big journal. The strange thing is: I find all these things relaxing. My conclusion is: I am quite a happy but not a modern person.
It is now more than 50 years since I met my first patients. After 20 years as an internist, I have now been working with primary health care for 30 years. We do about the same things as 30 years ago; nevertheless my feeling is that much has changed.
Swedish GPs have long had problems with their identity, and the situation is the same today. We do not even know what to call ourselves. We call ourselves district doctors, house doctors, family doctors, but we are not pleased with any of the designations used.
The meaning of the Swedish word distriktsläkare, district doctor, was what drew my attention to the field of primary health care. I was expected to be responsible for a defined area. In that area my task was to take care of my patients’ diseases and illnesses but also to undertake preventive measures in order to prevent diseases and illnesses. I was also a great friend of team-work, and according to my view the GPs together with the district nurses were the corner-stones in Swedish health care. This was the Swedish model as it worked in the 1980s and early 1990s. I felt that my GP colleagues were very proud of their job. We could create ‘model primary health care communities’ with ‘model primary health care centres’, where we tried to optimize both care and preventive measures, for example in the community of Habo. We were able to show that during our observation period the mortality from cardiovascular disease and stroke decreased dramatically more in Habo than in Sweden as a whole Citation[1]. I believe in good care of the patients, in continuity, in team-work, and in prevention.
I understand that my way of thinking is old-fashioned today. Competition, quality, evaluation, cost-effectiveness, and ‘choose a doctor’ are now the buzzwords in Swedish primary health care. I am afraid of the future. In Sweden as in the United States and in many other parts of the world we are now discussing high salaries and bonuses among top executives. Much wants more. I just hope that we physicians are not like them. Hopefully GPs will continue to do their job because they love their work and not just in order to earn money. The GP who wants to earn a lot of money will in the future have to reject very sick people. If you are going to be paid according to your results, it is advisable to treat people who are not necessarily in need of treatment. Your patients’ blood pressure will be perfectly low when you prescribe drugs to those who in fact had not needed them. There will be a system change in Swedish primary health care. Modern times will come. I am glad to be retired and no longer having to compete.
Just the day after having written the text above I happened to read the feature article of the local newspaper, Göteborgsposten: ‘Swedish health care is confronting a number of changes. It is obvious that a stirring is necessary. Some persons warn and say that the new-fangled things may increase the divisions in society. I believe in the opposite. Not least as they are based on the choice made by the patient’.
The writer had not read my editorial when she wrote hers. She seems to have understood modern times. Calle BengtssonProfessor Emeritus Interim Chief Editor
References
- Lingfors H, Persson L-G, Lindström K, Ljungquist B, Bengtsson C. Time for a ‘vision zero’ concerning premature death from ischaemic heart disease?. Scand J Prim Health Care. 2002; 20: 28–32