Reader response: Politicians are to blame when patients cannot see the same doctor

Patients should not direct their anger at individual doctors when they cannot see the same physician repeatedly, argues doctor Alexander Dangler in a response published by Dagens Nyheter.

He sympathizes with patients who have had to change doctors several times, but rejects the idea that individual physicians are responsible. Many patients cannot choose a permanent doctor because the clinic they rely on, for practical or geographic reasons, cannot offer one.

Dangler places the main responsibility on the regions’ reimbursement systems. At several clinics where he has worked, he says, the financial incentives favor seeing many separate patients with simple complaints rather than spending time following the same patient over a longer period. He says this can also damage doctors’ motivation, a risk previously highlighted by Sweden’s Association of Local Authorities and Regions.

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The regions have created a huge circus in which patients and doctors have to dance around among health centers.

The clinics themselves operate under difficult financial conditions. Dangler cites Competition Authority figures showing that 41 percent of Swedish health centers reported losses in 2014. The authority recommended higher payments, but politicians instead pushed for more competition, hoping patients would continually switch to “a better health center.”

Dangler says that goal is elusive. Research cited in the debate indicates that continuity with one doctor, even a poor one, can be more valuable than seeing several good doctors at separate visits because the doctor can follow the course of a patient’s condition.

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A better health center.