No Second Opinions
In Norway you have to register with a doctor. You can only register with one doctor at one time and this registry is recorded in the big government system. You cannot register with any doctor you want, only doctors that have available places at their clinic. This is so the doctor-patient love can be spread around. It is not uncommon to have to trek across town for a doctor as the one next door already has his quota of patients. Because of all this ‘registry’ it makes it mighty hard to get a second opinion.
To see another doctor you have to de-register with your own and then register with another (- only if the other doctor hasn’t filled his quota.) You do this by going to the government doctor reregistering website to change. You can only go to the new doctor once the registration has been complete – meaning the government has sent you out a confirmation letter. If you want to go back to your first doctor you have to go through the same routine. De-register, re-register, and wait for the letter. You are only allowed to change doctors twice in any given year. It sure sucks if you want a third opinion.
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Norway enters the Christmas season early.
In the winter we rest.
How do you like the darkness?
Reindeer herding is more than just an occupation, it is a way of life and an integral part of the Sami culture and identity.
In Norway, there are still Lefse recipes around from the 1630s! This is supposedly the traditional and original Hardanger recipe used:
The darkest day of the year is known as winter solstice.
Well. You don’t HAVE to register with a doctor. But it is sure convenient to have a personal physican if you should get ill. Otherwise you’d have to go to the emergency room.
And it is the doctors themselves who decide if they can handle more patients. Or if they don’t have enough time to give proper attention to more patients. So its the doctors themselves who decide whether their lists are open or not.
You can’t force a doctor to accept more patients than he thinks he can handle.
Otherwise the whole “second opinion” thing isn’t really a part of the culture, possibly because of a different tradition in medical certification. You’d normally ask to see a specialist instead.
And because the system is very accessible to everyone compared to many nations, when we had all the physicans open to everyone we ended up with drug addicts “shopping around” seeing every doctor in town while looking for a “soft touch” who would write perscriptions for pills.
So now, if you are worried about the competence of your doctor, you change doctors or see a specialist to check.
Or just pay for it privatly, of course. I think Klinikk Stokkan would give you an appointment if you pay for it.
There is the economic aspect of it. The system will pay for doctors appointments when you need them, but it prefers not to pay for many more appointments than the doctor thinks is medically nessesary.
If the parctice of second and third opinions were to become common here, the number of doctors appointments would increase exponentially, and with practially no medical benefit.
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from L-Jay:
Moose started nodding his head with the mention that ‘no second opinions’ is part of Norwegian culture. However, do you think second opinions might become the culture soon? I see Oprah and her Dr Oz telling everyone to get a second or even third opinion. (Not that I watch Oprah all the time
). It seems to be explicitly part of American culture. With the influence of American culture creeping into Norway maybe in 10 or so years it could became popular to have several doctors at once …lol.
But I personally like having a ‘family’ doctor. It used to be done that way in Australia when I was little. Our family doctor was Dr Chan who saw three generations of my family. Now in Australia you register with a clinic, not a doctor, and therefore are expected to see any of the doctors on duty. You can also be registered with all the clinics you want…lol.
I’ve tried to get a doctors appointment in Oslo without registering – very hard. I wanted to ‘shop around’ to find a good doctor I liked…lol. In the end I just had to pick a name to register with. I wish there was a way to find out about your doctor before having to commit through registry. Moose said that having to register is a way of making things fair. Most people prefer to go to experienced GPs. If we could all freely choose our doctors then all the just-out-of-school GPs wouldn’t get any patients.
Thanks for the valuable info – you can see that my experience is only from a ‘new immigrant’ perspective…lol. I’ve still got lots to learn.
So, it’s hard to find a good doctor you like in Norway, too… but once you find one, can you get an appointment in a timely manner?
I’ve had this same problem here in the US, but finally (after ten years!) have managed to find one!
It’s very frustrating that the medical bureaucracy everywhere seems to want to treat doctors as interchangeable widgets… personally, I find that it’s very hard to find one that fits me!
@L-Jay: Personally, I don’t think the “second opinion” is going to be popular here, at least not as part of the public system. If half the people going to the doctor wanted a second opinion, and a quarter wanted a third one, we’d have to almost double the number of GPs, the number of offices, secretaries etc.
Now, how often does a second opinion actually tell you anything new? I am sure we have all heard stories and anecdotes, but in terms of the overall numbers…the vast majority of the time the second opinion just confirms the first. (Except when you go to a specialist, but that is baked in already).
If we were going to fortify the health care system with that amount of money -enough to double the number of GPs in the country- there are a lot of ways we could get much better value for money, healthwise.
The way I could see it happening is as a product from the private sector. Stuff that people want, but isn’t medically required, often end up being supplied there.
Finding a good doctor that you like isn’t a problem I’ve encountered, but most people in my circle see their doctor so rarely that its never been an issue. The actual lists at Min Fastlege gives some information like number of patients on list, age, sex etc. I suppose you could ring up the office to make sure the doctors speaks good english.
I only changed my physican once, when I entered a period of lots of travelling at work. My old doctor was a great guy in his 60s, but I wanted someone I could consult by email.
If you really want to get a second opinion, I’d try giving one of the private hospitals in Tromsø a ring. Tell them that a second opinion is part of your culture, and invent a long-distance overprotective parent who won’t stop fussing until you do get one;) And be prepared to pay for a private consultation.
@Sarah K: On the subject of waits for appointments, that is part of the reason for listing the number of patients each doctor has on their list at the website. Doctors with lots of patients on their lists may have more crowded schedules. Normally, anything urgent should get you seen quickly, but for a general checkup, you’d get an appointment a few days down the line.
Response time can be a problem for people who chose to live in remote locations and have a long way to travel to see their doctor. (Also, remoter villages are hard to recruit medical personell to).
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from L-Jay:
Interesting. You know, the public health care actually uses the private health care…lol. One of our relatives was sent down to a private hospital in Oslo for an operation as the public health system couldn’t fit her in at the time. She stayed for a week – full expenses paid by the public health…lol. You’d think it would be cheaper for them to just do the operation themselves.
But yes, whenever I book in for a doctor (midwife, ultra sound tech etc) I always ask for a person who is comfortable speaking English. I’m amazed at how many doctors don’t speak English. I thought it was necessary to study medicine. But I always have to take my personal translator along (Moose) just in case.
I think second opinions are valuable. At my GP I was tested for protein – it was present but the doctor said that it was ok. When I went to the ultra sound clinic the next day I mentioned it just in casual conversation. Their ears pricked up. They got me to do another test. Again protein was present and I was admitted for an emergency induction of labour. I was lucky I had the second opinion because the baby and I were in danger. The hospital staff were very angry with my GP for not doing anything. Second opinions may be a waste for the majority of cases but I think they are worth it when it means saving lives for the other minority.
Ah, but it was caught by the people in the specifc field, not the doctor. Would it not make more sense to spend money strengthening the specialist services and making it easier and more common for people to visit specialists?
I think specialist services tend to be the areas where the health regions run out of money anyway:)
You don’t really need to speak a foreign language to study in Norway. Except if you are studying foreign languages:) But it is very common for doctors to speak english. They need exceptional grades in all subjects to get into med school, and its useful to broaden their available literature etc. While they are studying. Afterwards, it may become like high school French. It gets rusty and then athrophies. Many doctors may simply not trust their english enough to try to communicate in it. They are just as capable of being embarrassed about or insecure in their foreign language skills as anyone else.
But the young tend to be much more natural english speakers, in general.
And yes, the public system makes quite a bit of use of the private one. Partly because of the law that sets limits on how long people can be made to wait for medically neccessary stuff, and partially because -the private system can specialize.
A public hospital have to do all sorts of work and operations. A private one can specialize in only the profitable ones, where patients are not required to stay for long recvery times afterwards.
They buy all the latest stuff for their area, and don’t need a budget for things outside it. Their surgeons get a lot of practice in their area, and overall, they can get far faster and more effective than the public system.
So a noticable percentage of operations are done in the private sector, but paid for by the public.
Some people express concern that this practice directs resources away from the public system though.
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from L-Jay:
The funny thing is, the ultra sound guy who caught my condition was a med student…lol. His supervisor was on rounds. It was the doctor and midwife after I was admitted that was angry with my GP.
But sometimes the GP services are annoying and need more personnel too (more money to hire) because when you need them most they are closed. Our GP clinic is only open business hours (and closes early on Friday). If one of my kids gets a fever Friday night we have no where to go but the emergency room – and they get annoyed as they say ‘why haven’t you gone to your GP?’ One time my daughter had a serious fever and we were waiting forever at the emergency clinic. They too only have very limited resources. We ended up going home because Lilu needed to sleep. The next day we found out they had a psycho in with the doctor who had just killed three people with a knife including a pregnant woman. I needed at least four cops to maintain him. I don’t understand why they didn’t tell us all in the waiting room to go home, first for our safety, but also because no one was going to be seen that night. (The next day Lilu’s fever turned for the worse and we were rushed to hospital in an ambulance.) I guess this sounds like a horror story…lol. It was at the time.
But I’ve had a lot of contact with medical practitioners because of complicated pregnancies and the Norwegian Health service, even though it is very ‘sparse’, I think it is the best care I’ve ever had. I have respect for it as it is smart and works with natural methods. Rather than giving pills, practitioners teach you how to take care of ailments yourself. I guess that’s how they save money but it also enables people to be active in their health.
I’ve never met my ‘prescribed’ doctor, a Vietnamese man a couple of towns away. I go to a local private place in the next town who are very efficient and on the ball.
They even helped my mother when she was visiting here and made her feel very relaxed. My folks were impressed and so am I. For a busy mum it is worth it’s weight in gold to be able to go to the doctor when suits us.
I know you have to pay, but I’m sure Oprah and Dr Oz would approve if in your situation.
Very interesting discussion you are having here. I worked in different health care systems in Europe and US. There is an international rating of ‘best health care’ in which Holland was best, but I see many dutchmen crossing the border exactly for that second opinion and to have private treatment. Obama will finally try to correct some aberrations in the US system and the money for Oprah’s second and third opinion will partially be required to pay for that. It comes indeed down to personal trust but also organised measurement of treatment outcome of clinical groups (from hopitals down to individual healtcare workers). I trust Norway is very well organised in this affairs. I would not be suprised if many parameters of healtcare quality are open for public scutiny. Let me know if you found them.
Just today, Moose cut his finger really badly doing the washing up. He couldn’t book in to our local GP as you need to call between 9-10am for emergencies. So he went to the emergency clinic at the hospital to get stitched up. The nurse at the emergency clinic asked why he didn’t go to his GP and he told her they said they don’t take emergency bookings after 10am. She said ‘I’ll see what I can do’. She called up and now Moose has an appointment with his GP at 2pm. Funny how things work in Norway…lol. Wish us luck.
Was just wondering, could you please L-jay post the website to request a new doctor here in norway. I have been over run with stress trying to locate things, and if you could help, I will say .. Tusen Takk!!
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from L-Jay:
Here is a link to the first info page on changing your doctor (this is a new webpage – you used to do it via NAV). It is in Norwegian:
http://www.helfo.no/privatperson/fastlegeordningen/Sider/default.aspx
Isn’t everything in Norwegian? hahaha Thanks so much L-Jay! I am struggling since moving to Norway to understand the Norwegian Medical System. Since coming I have had 8 surgeries, and many more hospitalizations. I don’t know the Norwegian Language and have gone from scared to MAD. I keep asking my doctor through tears if she even wants me has a patient or is she just overwhelmed. She can’t even diagnose an infected wound (leaving me to suffer ungodly pain for months), that by the time I got to see the plastic surgeon, he was *so* shocked that I hadn’t had medical attention over it. I clearly saw him roll his eyes in disbelief, even though I told him I see my doctor at least every 2 to 3 weeks for the past 8 months and have pointed it out to her on EVERY visit. And that is only ONE example of my doctor’s incompentence. I don’t just want to de-register from her care, but desperately want someone to know this doctor even practices medicine! I have been trying to write NAV and even the HEALTH MINISTRY about her, but the emails come back saying they have forwarded my concerns to someone .. (or could it just be a unknown black hole in space?) Either way, today is the day, I campaign to assert my rights as a patient, immigrant or not, and get some answers. Thank you for heading me in the right direction!
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from L-Jay:
I know the annoyance of having an incompetent doctor. I have come to distrust certain medical personnel. I find that the ones who dismiss your concerns are they ones to watch out for. It is really important to mention every ailment and concern you have at each appointment. I did to a ‘fill in’ doctor one day (as my regular doctor was on holiday) and she noticed nothing so the next day at the hospital I mentioned the same ailments to the doctor and he realised I had pre-eclampisa and needed to be induced right then and there for the safety of me and the baby.
The one thing to remember is that it is not the system but the individual doctors themselves that’s the problem. Norway, in general, is very trusting. If a doctor has a doctors degree it is thought ‘well, they must be ok to have gone through so many years of study’. It seems like there are no quality control checks – maybe a kind of ‘mystery-shopper’ or ‘mystery-patient’ system needs to be implemented to take out the doctors who are incompetent, who give Norway a bad name.
Ya know L-Jay, I really liked your sincere response about the fact that Norway does have a very competent medical system, and I so agree. BUT……you must know, that within less than a month from moving to norway, I had to go to their *urgent care* center where I explained to them, that my right leg has a partial blockage before leaving the USA, and that it was now *dead……..and I needed medical care, right now* The leg was very swollen, and without circulation. But for over 4 hours I sat, before being seen, only to be seen and have THAT doctor, scream out, this woman’s leg is dead, call and ambulance right away, and then yell at ME for sitting out in the wait room for 4 hours!
I can only tell you, within an hour I was in surgery, where they sliced my leg open, to stop it from dying from what is known as *compact leg syndrome*, .. and had to repeat this surgery 5 more times! Now, my leg is saved, but is scarred from my knee to my ankle on both sides of a thin patch of tissue. Needless to say, I was a print model in the USA, and known for my LEGS. Now people stare in shock, and have even puked. But I am so happy the vascular team at the hospital saved the leg.
But, when it reblocked, and I went to my doctor, weekly to tell her, she kept looking off in space, mumbling *when do you see vascular again?* and as you know, in norway, SHE has to arrange any appointments outside her office. But guess who got yelled at by vascular when they had to do 2 more operations to save the leg? HELLO……ME.
She is going to kill me, I swear, cause this is only now 2 examples of her incompetence, .. the first mentioned, being the infection she kept ignoring in the skin graph from the wound, and now the second thwarted disaster.
I *so……………………..*, can’t begin to tell you the long list of other mess ups, that once hospitalized, I am the one getting yelled at, and now sadly, they don’t believe me that I even see my doctor every 3 weeks at least. SIGH…………CRICKETS CHIRPING..EYES BLINKING..MOUTH OPEN
So, after the holidays, I do plan to contact someone for help getting me out of her care! But in meantime, all attempts to call that doctor to get refills on meds, has been met, by *busy network*, for past 3 days…sigh. So THANKS again L-Jay, cause of you, I finally believe I will get out of this medical horror, and de-register, in my quest to find a new doctor, and get WELL quick…smiles
Btw… I forgot to mention, there is such a service, to take out these doctors. And it’s free to anyone. I just have been in and out of hospitals so much since I came, that even though I asked everyone in the hospitals, about a *complaint board*, I was told *no, nothing like that here in Norway.* Ha! I found, in the lobby, next to reception a brochure telling me they will help me for free, AND, perhaps even compensate me from any medical harm done.. so if you want me to post information about that, please, let me know, and I sure will. Being an immigrant makes it hard at times to navigate any system here in Norway, but together we can accomplish much, .. no? smiles
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from L-Jay:
Your experience is full-on and I’m sorry you’ve had such a tough time. In all seriousness, and regards to your health, if you know you can get better care and treatment in your home country it might be best for you to return. I know that you might love Norway and your family is here but if Norway isn’t giving you what you need to save your leg (or your life) then, for yourself and your family’s sake, go where you know you can get the proper care. You don’t need to stick it out here in Norway and try to change the system as you go – it is not worth risking your leg or your life. If you were terminally ill and want to change the system for other people then it is a noble cause but sacrificing yourself by staying in Norway when you have other opportunities is not the best for you or your family.
Don’t sacrifice yourself because you want to stay in Norway. If you are staying because you get your medical treatment for free then you will just have to work with the system (if you beat it, let us all know how you did it…
). The thing is, you can’t change Norway unless you change Norwegians and Norwegians don’t want to change – they love Norway just as it is. At this time YOU are most important, not the changing of the Norwegian medical system. (You are already know this but I’ll say it anyway…) Look after yourself first, do all you can to better your treatment by questioning, getting informed and knowing everything that is going on. That way you will be able to know for certain when a medical physician isn’t all there. You can change things for yourself first and after you’re through it then you can change things for other people.
I also understand Norwegian medical physicians getting angry …lol… when they find out what my other physicians are doing (wrong). Well, it seemed like they were getting angry with me but I’ve discovered that Norwegians have an odd way of expressing anger. When I said to Moose (who was with me at the doctors) ‘I don’t understand why he was getting angry at me’, Moose had to explain that he wasn’t. I didn’t understand – the doctor was looking at me, raising his voice with an angry frown asking me why nothing was done about my condition as if it was my fault. But nope – Moose said he was ‘being angry to the wind’. It might have seemed like he was angry with me but he was angry at the situation and didn’t understand the English custom of not making ‘English-speakers’ feel uncomfortable or to blame. Norwegians tend to project their anger to anyone who is present at the time no matter the subject of the anger – it’s just their way and it is not meant to be taken personally. However, when English-speakers are with someone who expresses anger that way we think they are angry at us. It’s a conundrum…lol. It is easy to think that Norwegians have the same psychie as English-speakers because they are caucasian, westernised and have a similar language but it is best to think of Norwegians as a different race – that way their odd behaviour will be more appreciated
It’s a fact, Norwegians are weird but they are so cute…lol.
I just decided to reply on this post, one last time. I again, want to thank you, for your help. I did not in any way intend for my comments to lead you to think I came here JUST for the Norwegian Free Health System. Or to think I want to change the system. I continued to *keep* the same doctor because I believe that since the relationship between myself and her started with a medical crisis that in time, we would get to know each other better, and things would turn out better. I realized she and I needed in time to develop the doctor/patient relationship, per se. But clearly, she is incompetent and it is time for me to move my health care to a new doctor.
I am a bit surprised about your need to tell me to get my butt across the border, and back to America for health care. Would we all not agree that all over the world, people, in all professions, have those that lack judgment or skills? Of course, it is a *fact of life* as they say. But I am not about to leave my *family* here, when simply a change in doctor would be less *rash*.
I have been following your posts since moving here. I have read your views, opinions, and fears being an immigrant and wading through the system.
I also understand your true desires to *parent* your children as you see fit. I simply wanted no less, to convey my thoughts, and seek some advice. The medical systems of your country, my country, or our *new* country all have comparisions to our *own* views on what we think is best for ourselves, our families. I am grateful that you and Moose found ways to smuggle in bottles and forumla to feed your child, when you *chose* not to breastfeed. Or even when faced with the reality that you had a medical condition that went undiagnosed but thankfully saved you and your baby. But at NO time would I have commented to get back to Australia. I am going to apologize up front, if I misunderstood you when you implied I should leave Norway in your last reply. But I was offended and shocked none the less, that you even said I should.
Your website has value, and has helped many with your attention to detail with the norwegian history, past, present, and continue to look forward to reading more in the future. However, I am mindful that anything you post comes from your experiences and opinions of the Norwegian people. I don’t think so much that norwegian’s are strange, quite the opposite, the word I would say is *efficent*. Now my job is to find an *efficent* doctor.
I wanted, in ending, to comment that I also follow another website of an american, like myself, who moved to Norway as well. Between her website and yours I get a rounded sense of views and opinions. That is what makes me *not* so rash to rush back to america, and instead stay right here in Norway. I think we all, will never stop wishing for the days of yester and the memories of how they did or do things in the countries we came from. But I intend to move forward, and embrace the simple fact, I strongly believe NORWAY has and continues to do things the best way, and am forever grateful they not only think of me, but for all people born or crossing into borders way off in the future. In fact, truth is, I am shocked anyone would aspire to move to America, the so called land of the free, when …HINT……Norway actually is more FREE …at least here you can take a walk to enjoy nature, and not have to pay or be arrested for trespassing to do it. Oh gosh, do NOT get me started on comparisions between America and Norway…lol
Ok L-Jay, bless you and yours, and thanks again. I am sure in the future, I will comment again on something you post on your website. I wish you the happiest of adventures and look forward to sharing the pictures and stories about them with you.
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from L-Jay:
Hi Julie
Thanks for your reply – I think you might have misunderstood my meaning. My reply was in the vain of ‘if all else fails’. As a last resort – If I was in the same situation as you – my leg was going to die and Norway couldn’t do anything about it (or was too incompetent to do anything) but Australia could, I would move back to Australia with my family. I believe my health and life is more important than the country I am living in (Australia or Norway). I would never risk my life or leg because I want to stay in Norway. Of course going back to Oz wouldn’t be a permanent thing – when I got be better I would move back to Norway. What I want is the best medical treatment I can get and if Norway isn’t able to give what I need I have the option (which is more than many other people have who live in Norway) of having another country to go to.
I am CERTAINLY NOT saying “if you don’t like Norway go back to the US” (I despise this way of thinking as as an immigrant I face it often) – but I am saying if Norway can’t save your leg because of the ‘system’, you have the choice of going to another country to get the help you need.
I guess even the chance of loosing a leg would effect me greatly as I rely on my leg for work (being a dance instructor). I personally would go back to Australia in a flash, if I didn’t trust the competency of medical practitioners in Norway, if it would save my leg. However, I get from your comments you are not too keen on the US anymore so I guess you have decided to stay in Norway and accept whatever happens. However, I don’t think you should rule out seeking medical treatment in the US if you need to as a last resort – we know of people who have gone to the US because Norway couldn’t do anything for them, especially for heart and cancer treatment. Just think about it as another option just in case things go wrong here in Norway.
***I am very interested to know your journey and I’m sure other readers would value your experiences with the Norwegian medical system. Do you have a blog that you could link us to here? – if not, we could open a post for you here on My Little Norway where you can make ‘diary entries’ via the comments field, if you would like. I think the information you will have will be important for other people.