Health post: Hospital visit

Last week in Gothenburg, I was able to visit the Sahlgerenska University Hospital, which is a huge hospital in Sweden with many departments and one of the six places in the country where people can study to become doctors. I met with a doctor named Axel who got his PhD at Sahlgrenska and is now doing his residency there. He gave me a tour of the hospital campus, a large and beautiful place with lots of red-brick buildings. According to the hospital website, there are 16,000 employees at Sahlgrenska and over a million outpatient visits there each year.

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A map of the hospital from the Sahlgrenska website.

The various departments at Sahlgrenska seem to cover every aspect of health, from basic care to various specialist treatments. Sahlgrenska’s departments include dentistry, acute care, trauma, cancer, cardiovascular care, rheumatology, oncology, neurology, ENT, gynecology, geriatrics, diabetes, urology, Parkinson’s, reconstructive surgery, child care, and more. Axel pointed out a ward for patients who have attempted suicide, who can be legally kept under supervision for 24 hours or more depending on the case. He also told me that Sahlgrenska is the only hospital in Sweden with the ability to transplant any organ.

Later, sitting down with Axel, I asked him about his opinion of medical technology. He said, “if it doesn’t help the patient, [at least] it helps the doctor.” Personally, I was happy to hear this view because I’ve only heard from companies and academic institutions so far. Both have focused on the functionality of medical products, user-centered design, and how users can access medical devices. Very few people have mentioned the opinions or involvement of doctors. This is probably because I’ve been focusing on medical devices for use outside of hospitals (home care, eHealth, wearables, etc.), which doctors never need to use. They can provide an expert opinion, however, especially when it comes to medical devices used for inpatient care.

Axel said that the future of medical technology in Sweden will be telemedicine. As an example, he told me about a small home care machine used by some patients with inflammatory bowel disease. If these patients have a worrying symptom, they can place a sample of their feces on a dish in the machine. The machine analyzes the sample and then flashes a red light if the patient should come into the hospital or a green light if there is nothing unusual to worry about. This saves time and money for everyone.

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The main entrance to the hospital, in the middle of the campus.

Axel suggested that Sweden’s health care system is so successful because it is free for the public and well-organized (rather than because of its access to technology). Since Sahlgrenska has departments spanning so many aspects of care, there is a standardized care chain. For example, if you need a surgeon, your doctor will know exactly who to contact. If someone is sent to the hospital in an ambulance, their ECG is taken in that ambulance and sent immediately to the hospital’s acute coronary care division so that the doctors there are ready for the patient’s arrival. If someone needs an x-ray, they can get it within 7 days. (If for some reason the wait is longer than 7 days, Sahlgrenska has relationships with private medical imaging companies and can use their services). The different doctors involved in one patient’s care can all sit together and have a conference about how to proceed with treatment, and they do.

I asked Axel about different types of patients, as one of my questions for this project is whether or not cultural attitudes towards medical technology differ between generations. He said that older patients tend to take the doctors’ recommendations most seriously. He has found that younger people fall into one of two camps: either they don’t care at all about what the doctor says, or they have read too much on the internet and have committed to a self-diagnosis (often thinking that their condition is far more serious than it actually is, which happens to me whenever I go to WebMD.com).

He also mentioned Sweden’s increasing immigrant and refugee population, which can be difficult to manage because the Swedish doctors don’t know the different cultures and languages of their own patients. I’m not sure what Sweden is doing to mitigate this problem.

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The north entrance to “Sahlgrenska Sjukhuset,” the Sahlgrenska Sick House. The hospital started with this building.

Despite Sweden’s high level of care, Axel told me that people complain, mostly about having to wait on line at hospitals. Axel himself said that having to deal with bureaucracy and administration is the most frustrating part of his job. When someone comes to the hospital, he can figure out what they need and where they should go after a simple 10-minute exam. But then he must spend 30 minutes registering the person into the hospital’s computer system, assigning them to a particular ward, getting charts for them, and so on. The large size of the administration makes these tasks more complicated than they should be.

Axel said that maybe 6-10% of Swedes have private insurance in order to get treatment and operations on a faster timeline (according the newspaper “The Local,” it was 10% in 2014: http://www.thelocal.se/20140117/hospital-queues-tied-to-insurance-trend). This reminded me of my conversation with Mårten at Emmace (the inhaler company), when I first heard that the main problem with Swedish hospitals, and perhaps free healthcare in general, is the long queues and waiting times for even simple operations.

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This is the only picture I took of the hospital interior, as the other areas I saw had patients. The textured path on the floor (thin, raised grey lines) is to help visually impaired patients navigate the halls.

I steered the conversation back towards medical devices then, asking Axel what makes a good device. He said there are three main requirements:

  1. Reliability. This means that it has been thoroughly tested with trustworthy results.
  2. User friendliness. “Of course,” he said.
  3. Physician’s preference and experience. It must be recommended by physicians and perhaps have been developed with physician input.

He said that low cost is not a requirement, though it is a benefit; if a device is good enough, Sahlgrenska will purchase it regardless of the cost.

I asked him if there were any medical devices he hated. He laughed at this and said that he gets frustrated by mechanical heart pumps – specifically the HeartMate II, a left ventricle assist system, and the Berlin Heart, a bi-ventricle assist device. Ventricle assist systems help patients with advanced heart failure, often seriously ill patients waiting for heart transplants. Axel told me about a patient using the Berlin Heart, which comprises of a big box controlling two pumps that connect to four tubes attached to the heart. It stopped working in the middle of the night once and needed to be hand-pumped. Then this happened two more times. It sounds like a terrifying scenario; these are large, highly invasive devices, and of course it can be dangerous to hand-pump a patient’s failing heart.

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Here you can see the pumps and the four tubes of the Berlin Heart system. What you can’t see is the large pumping system that the patient would be plugged into (source: http://www.internationaltradenews.com/berlin_heart_gmbh/portrait/).

On a more positive note, as I mentioned earlier, Axel thinks that the medical technology of the future – for both rich and poor countries – will be telemedicine and home monitoring devices. For Sweden specifically, telemedicine can help the problem of long lines at hospitals, as doctors will only have to see patients that have been recommended after an at-home screening.

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In the background, you can see the trauma area where patients can be transferred directly  from ambulances to operating rooms.
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