once again, something is rotten in the state of the danish medical system

it has, once again, become necessary to write a biting letter of complaint to my local doctor's office. i have only stripped the full names from this version, but otherwise, it's as i delivered it to the doctor's office today, capital letters and all. i'm putting it here so i remember what happened and when. sadly, it probably won't be the last such letter i have write. if you want a bit of insight into the danish socialized medical system, read on...

Dear Lægehuset,

It’s been awhile since my last letter to you (that was back in March 2012). I hoped I wouldn't have to write another one, but it seems that I do.

I have had contact with your office on a number of occasions over the past week, due to severe and debilitating pain in my back. Because I knew from past experience that it likely wouldn’t end well, I actually visited the physiotherapist/chiropractor during the efterårsferie, when the issues began, instead of calling your office. However, when the problem took a turn for the worse last week, I had to call. I was, unfortunately, not at home when the problem started, so the first calls were on the phone - one with the assistance of a chiropractor in Copenhagen and the second one (which actually took more than 5 separate telephone calls and a nauseating amount of “ik' aws” from the secretaries to accomplish) myself on Friday, October 30. The first two calls resulted in prescriptions for Diclofenac and Tradolan, neither of which seem to be even remotely effective against severe back pain. (You’d think that you, being the doctors, should know that.)

On Monday, when I returned home, I called for an appointment and saw dr. MM. He took my pain rather lightly and sent me on my merry way to the physiotherapist with very little advice or insight into what might have caused my problem. Happily, the local physiotherapist is much more thorough and professional and dare I say, interested in his work (you all could maybe take a lesson from him on that front). He put me through a battery of tests and explained that he was pretty sure I had a slipped disc at #4 (up higher than the usual slipped disc), and said that I needed an MR scan to confirm it. Luckily, he made the next phone call to dr. MM and I was put into the system for a scan immediately. The physiotherapist also recommended that I have a steroid blocker put into the secondary issue of bursitis in my hip and sent me back over to the doctor’s office to get that, so that I could at least have a little relief from the pain.

Naturally, your office gave me absolutely no information on what the next steps regarding the scan would be. So, I called again on Tuesday during telephone hours and was huffily told that your office had nothing to do with scheduling, but I could call the x-ray clinic at the local hospital and ask (looking up the number myself, as no number was offered). It might have been an idea to give me this information when I stopped by on Monday afternoon to make the appointment for the bursitis block. I sincerely can’t imagine that I’m the only patient who would like information about what’s next and when it will take place. It doesn’t seem too much to ask, and yet, inexplicably, it is.

But, where things got really bad was yesterday when I came to my appointment for the bursitis block injection. I saw dr. TVM, tho’ funnily enough I don’t know his name from him presenting himself to me, I had to look it up on your website. I knew it didn’t bode well when he called my name from across the room and then didn’t even wait for me or greet me with a handshake until I had managed to find which room he’d gone into, far ahead of me. He could surely see that I was in severe pain and not able to walk quickly, but that didn’t matter. He was also very dismissive of whether I needed the shot and at first indicated that he wouldn’t give it to me. But, after checking my hip, he realised there was an acute need and agreed to give the shot. However, he just went and got a needle and the steroid, asked me to point out with my finger where it hurt most and then stuck the needle in and blindly shoved it around in a haphazard manner - not even using ultrasound equipment to find the correct spot as would be NORMAL and INDICATED and STANDARD PROCEDURE in such an instance. Then, without giving me a bandaid to cover the site of the injection, which was disturbingly leaking quite a bit of clear liquid, or letting me know that I could get dressed, he just went back to his desk AND OPENED THE DOOR TO THE HALLWAY. I wasn’t even dressed and furthermore, I was feeling very unwell from the pain and needed to lie down for a few minutes, but he was in a hurry to just get me the hell out of there. I was shocked, but in too much pain and feeling to unwell to protest.

I tried to ask about how I should remain still on my back for the MRI the next day, when I couldn’t lay flat on my back due to the pain. He just dismissed it and said I could try taking two of my Tradolan tablets ahead of the scan. This, despite me telling him that the Tradolan wasn’t effective in taking away my pain, except perhaps the top 10% of it. He just could not wait for me to leave that room and he was unafraid to show it.

When I got out to the counter, where I had to inexplicably pay 50kr for something or other that was inadequately explained (a clean needle? perhaps otherwise we’d have reused an old one on the foreigner?), I became very unwell while I was standing there waiting. I said, in Danish, to the secretary that I needed to sit down. She apparently didn’t hear me and came storming out the door into the waiting room after me, asking what was going on. I must have been white as a sheet and looking very unwell, but she insistently and loudly asked what was wrong, as if I were a small, dull child. There was no discretion and no kindness in it. I realise the office staff are not medical personnel, but it wouldn’t hurt to have a bit of bedside manner when you’re dealing with people who are already feeling ill or who might be in severe pain. Instead, I felt embarrassed and singled out by her loud, gruff treatment in front of the whole waiting room of patients.

Is this really the way you wish to treat your patients, or is it just the non-Danes? I admit I can’t help but think that my accent has something to do with the way I am treated like a second-class citizen. I would note that although I feel the need to write these all-too-frequent letters to you in English, I speak Danish when I’m at the office and have been in Denmark for 18 years, so I have a certain level of fluency. It also means that I have not misunderstood the way I’ve been treated. And I find it completely unacceptable.

You can feel free to call me if you wish to discuss in more detail. But, in any case, I’ll be eagerly awaiting word of what steps you will take to improve your interactions with your patients.

a couple of little rants about the rubbish service culture in denmark

christmas is over and we're in the liminal space, waiting for the year to end and the new one to begin. i went to bed with wet hair and woke up with what my mother would call a fright wig. and somehow, it's all making me feel rather ranty.

rant #1: post danmark

in the week before christmas, i received a ransom letter from post danmark, saying they were holding a christmas package hostage until i (as receiver of a package i had not yet seen) sent more information about the contents. they assigned the package a number and said it contained, "støvler, tæj, mm" from the USA and that it weighed 4 kilos. they did not say who sent it, nor was i able, even after asking google translate for help, to figure out what "tæj" was. so, i guessed that it was the christmas parcel from my sister and that they boots were the doc martens she got sabin for her present. so, i asked her for the receipt and sent it dutifully (pun intended) to post danmark.

i heard nothing. and more nothing. for a week.

so today i called and asked how it was going. they claimed to have sent me a letter (probably via post danmark, so its chances of reaching me are slim) saying i hadn't provided documentation for the other items - the mystery "tæj" and the equally mysterious "mm," which is the danish equivalent of "etc." since i am the receiver of the package, i have not yet seen the items which are in it, therefore, it's hard for me to document them unless you specify what the hell they are. why isn't this just common sense for post danmark?

the nice lady on the phone today could see that this was a problem. so she took my number and they are supposed to get back to me today. meanwhile, their own limit of 14 days is quickly passing and even tho' i've been in touch (twice now, once in writing and once on the phone), they will likely send the package back to my sister before it's all finished. and then she can resend it and we can start all over again.

oh, the joys of customer service in denmark.

rant #2: bus #214, licence plate TD 92845, tide bus company, driving for sydtrafik in denmark

a few days before school was out, it was a dark and foggy morning. i was right behind the bus as i dropped sabin off at school. he was in quite a hurry and gunned it away down the little side street by the school. there were two small boys on their bicycles, wobbily making their way out to the big street, where they waited to cross. the bus was right beside them and wanted to turn right. there was quite a lot of traffic and, i may have mentioned, it was very foggy and still very dark. so the boys were cautiously waiting to be sure they could cross the road with their bicycles. well, mr. important bus driver decided to help them in their decision to cross the road by beginning to honk his big, giant bus horn at them. they were wobbly and unsure anyway and the honk nearly scared them off their bikes. it did, however, also scare them into action, and he saved the 30 extra seconds it would have taken to wait for them to cross on their initiative, but decided to try to make it up for it by gunning it and roaring off down the street.

i was so taken aback, that i noted the license number of the bus and came home and wrote to tide, the company running those buses, asking them to tell their driver to be a little kinder to children in traffic near a school. they wrote back telling me that since i wasn't involved, they were going to ignore my message.

yup. danish service culture at its best.

rant #3: the hunt for the christmas turkey

danes eat pork roast and duck for christmas. turkey is unusual, but not impossible to source. most grocery stores have a frozen bird in their freezer case. ten days before christmas, i checked my local store and found their frozen turkeys were the size of large chickens (4200 grams was the largest - that's about 8 pounds). so i went over to the butcher counter and asked if they could get me a larger bird. the guy dismissed me with a snort, rolling his eyes at me, saying if i wanted a turkey, i should have ordered it 3 months ago. very helpful and service-minded. (that was the sarcasm font, by the way.) and way to go, super brugsen in give (i've got more examples of your lack of service mindedness, but i'll save them for another post).

so i began checking all of the other grocery stores and butchers in my area, driving to several other towns in the process. all to no avail, there were no turkeys of reasonable size available, frozen or fresh. then a friend sent me a link to a butcher in vejle (why didn't i think of that), which claimed to have a turkey that would serve 10 people left. i called them and asked if it was true. they said they had one bird left and mentioned to me that it was already stuffed with a mixture of minced pork and cream, but it was a fresh turkey, not horrendously expensive (at 440 kroner/$80) and i was desperate, so i ordered it.

and on christmas, i took it out and put it in the pan, thinking it looked a little strange, but i chalked that up to the pork stuffing and put it in the oven. while it was cooking, it smelled much more like pork than turkey, but i could live with that. then, the weirdest thing happened. i asked my sister-in-law, who is a trained butcher, to do the honors and carve it. and she discovered that except for legs and wings, it had been completely deboned! a boneless turkey for christmas. i find it a little funny that the butcher didn't think to mention that little fact to me. and how can i make soup now with no turkey carcass?

that said, it was delicious and moist. i had been a little worried that since it was stuffed, i couldn't brine it and make it tender, but the pork did the trick as well. and that pork stuffing was also delicious. and without the bones, it was much easier to slice, but i still find it rather weird and won't be repeating it.

and now, i feel amazingly better, having gotten that out of my system. thank you for reading!

the danes will not be winning any customer service awards

i have to share with you a letter that i wrote today to my local doctor's office. as those of you who are friends with me on facebook know, i've had a cough for more than two months now. today, i had an appointment for a "lung function" test (it's apparently the last straw when they can't figure out anything else), which i dutifully reported for at the appointed time, only to find that there was no appointment on the books. in frustration, i came home and wrote this letter to the doctor's office. i'm about to print it and deliver it by hand, but i had to share it here, capital letters and all. interestingly, my initial reaction is that this isn't even a question of socialized medicine, just an utter lack of customer service and perhaps empathy (and a little bit of being absent from medical school on latin day).  but i'll be interested in your take on it (and i warn you, it's long and it features two phlebotomists and a mean nurse).

here's a picture of a fluffy bunny to take your mind off how many words there are...

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Dear Lægehuset (House of Doctors),

I have to write in English because it’s easier to express myself and I trust that you’ll be able to make it out.  I have had a severe cough since the beginning of January. I’ve been in to your actual clinic 3 times (4 counting an aborted mission today, but we'll get to that).  I’ve called during the 8-9 a.m. calling hours at least 3-4 additional times. And here it is, March 5 and I’m now just really, really good at coughing and we’re no closer to knowing what on earth is causing a cough of such abnormal duration.

I’d like to walk you through what I’ve been through and ask you if think it sounds ok. The first doctor I saw was a young woman who was apparently taking part in a contest to see how many patients she could see in a day (or an hour?) - sadly, I never learned her name, nor was I invited to sit down or even remove my coat, so I cannot tell you who she was (tho’ I could identify her in a line-up if necessary). I was literally in and out in under a minute with nothing but a compliment for my excellent coughing ability.

A week later, after a couple of coughing fits that made me wonder if I should go to the ER, I called during telephone hours. A nice doctor with a very deep voice looked at my medical history and noted that I had had a similar cough in May 2010 and he suggested we try the steroid inhaler that worked at that time, so he called it in to the pharmacy for me and I went and picked it up and began using it as directed.

A couple of weeks later, ragged from the continued coughing, which wasn’t showing any signs of letting up and now getting quite sleep-deprived, I called again and got in to see another gentleman. He was apparently not in a competition that day and actually invited me to take off my coat and sit down, I’ll even grant that he might have told me his name, tho’ I didn’t take note of it and in the haze of my illness, I simply don’t remember. However, I felt that he took my cough seriously and he sent me in for some tests - a blood test and a throat swab, as well as an x-ray. Oddly, other than the x-ray, he didn’t bother to explain to me what he was testing for, nor what I should do next. I went out to the waiting area and was called in for a blood test. The phlebotomist taking my blood was nice, but didn’t explain what the test would be looking for or how long it would take to get results. She just sent me into another nurse’s room, where a nurse who NEVER SAID A SINGLE WORD TO ME (I can only presume because she and I had not met when we were in kindergarden together), not even hello, or “fuck you,” came at me with a long q-tip, not even asking me to open my mouth and say "aah," but leaving me to bewilderedly figure that out for myself while trying not gag on the stick she was wordlessly shoving down my throat. She also failed to explain what the test was for or what I was expected to do next. I made my way to the local hospital for my x-ray and dutifully waited for a call about the results as directed by the nameless doctor.

When no call came, I called in, but having no idea which doctor to ask for by name,  I took the first available doctor in your endless loop phone system. She (again, didn’t catch the name) was a bit short with me; telling me my results weren’t all in and behaving as if I should have known not to call so soon. Not being telepathic and having only dated a medical student during college and thereby only peripherally attended medical school, I had no way of knowing when to call for my test results, since I hadn’t been told. Nor had I been told what I was being tested for, which made it even more challenging to guess (google?) when I should call for the results. So, still coughing, and by this time a real expert, I waited ‘til early the next week and called again. This time, I was blithely told all the test results were negative (but still not told what I had been tested for). I asked if there wasn’t something we could do to get me some relief so I could get proper sleep, rather than waking with coughing fits several times per night. And the nice lady then called in a prescription cough syrup for me (giving me no warnings that I should be careful driving or operating heavy machinery, nor asking me if I had had previous issues with codeine products in the past (hmm, would have thought that was standard)).

I took a few doses of the cough syrup several evenings in a row, trying to get some sleep, but the presence of actual opium in it made me feel worse, so I stopped taking it and just continued coughing, which by now I was doing at Olympic-levels. In desperation, I came in for a third visit. This time, I saw Dr. M and I only got her name because I insisted on it and typed it into my phone as she spelled it to me.

What is up with not introducing yourselves? I realize that I’ve never seen the same doctor twice, so perhaps it’s unnecessary since you apparently have what I can only characterize as an endless supply or consider them disposable like one-time surgical gloves.

Dr. M tested me for allergies, as when I came in this time, I suggested that maybe the reason my cough didn’t go away was because it was a symptom of an allergic reaction. (See that, I came with the diagnosis idea and again, me = no medical school.) I learned to my relief that now allergies can be tested via a blood test, rather than the panel of pricks on your back that I had back in 1996 at an allergist in the US. So, I went in to the phlebotomist again and she took a rather alarming amount of rather alarmingly large vials of my blood. This time, probably because I knew her name, Dr. M told me the results would take a week and I should call again then, during the regular telephone hours.

And that brings us ALMOST to the end of our story. I dutifully called a week later and talked to a woman doctor (not Dr. M, as she wasn’t listed among those available on the numbers to press that morning) who said that I was very allergic to birch, but not to milk or wheat (which had been suspects, as I often have a coughing fit after eating dinner). I had to ask if there were any signs of allergy to molds and she looked again at the results and seemed unsure whether the last one was a mold or not (it being listed by the latin name - apparently not covered in medical school?), but yes, it showed that I was allergic to it, whatever it was. I asked what the next step was and she started advising me to have someone out to my house to check for skimmelsvamp. And while I appreciate homeowner’s advice, I was calling for MEDICAL advice. When I pressed her on that, she made me an appointment to come in for a lung function test today at 13:45. Someone along the way had suggested that I might need a lung function test, so I guess she was covering all bases. But, here’s where it gets ever better...I show up today for my appointment and the machine in the lobby tells me that I don’t have an appointment. I ring the bell and ask when my appointment is and the secretary tells me that I don’t have one at all. Now, I grant you that I am not a native speaker of Danish (hence the writing in English, which I assume you already got), but I did not misunderstand this. And I did not fail to note it down correctly. I repeated it back to her and she verbally confirmed on the phone and I noted it in my calendar.

And meanwhile, I continue to cough. My conservative American friends are having a fieldday with the story on Facebook as they think it has all the symptoms of all of the ills of socialized medicine written all over it. But, I don’t think it’s a question of that, it’s a question of customer service, or an astonishing lack thereof. And a symptom of a system where I have never been assigned a doctor that is MY doctor and knows me, but instead get bounced around and “practiced” on by an endless array of one-time doctors. But I can tell you, as limited as my attendance in medical school was, it is NOT NORMAL to cough - really, really cough - for two months straight. Oh, and by the way, tho’ not a single person asked me along the way, I am NOT a smoker.

I’m very interested to see what happens next.

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i'll keep you posted.

i guess there's a good reason why they call it "practicing" medicine. they're really just practicing.