The health care centre at first
Sometimes it can be difficult to know where to turn for health care. For example, where should you look if you're experiencing back pain, stuck with a stubborn cold, or have a severe stomach ache?
Usually, you should seek help at the health care centre for all ailments that do not require immediate hospital care, such as acute or life-threatening conditions. If necessary, the health care centre refers patients to other specialists. On evenings and weekends, seek help at the local emergency healthcare centre if you're having a problem that can't wait for regular health care centre opening hours.
This text explains in general how the outpatient health care is structured, and where to turn for help, although slight variations between county councils exist. To get detailed information about how health care works, you should find out what applies to the area you live. The blue pages of the telephone book contain information on opening hours for health care centres and emergency clinics. For further information, consult your local county council web pages.
The Health Care Hotline advises and informs
It is not always easy to judge by yourself how sick you are. Most county councils offer health care counselling by telephone, where experienced nurses assess the problem, give advice, and – when needed – information on where to seek help. The wait can be shorter and the health care better if patients know where to turn. Those who are sickest get quicker help at the emergency clinic, and those with less threatening conditions avoid long waits. This benefits everyone.
Health care is divided into outpatient and inpatient care
The Swedish health care system can be divided into two major parts: outpatient and inpatient care. Outpatient care means that the patient goes back home after being treated, while Inpatient care means that the patient is admitted to hospital for treatment. The greater part of health care is outpatient care. The health care centre and specialist clinic are described first, followed by a description of the emergency clinic, which is often the path towards inpatient care.
The Health Care Centre
The health care centre - the place to turn to first
The health care centre is the foundation of Swedish health care. It has many names and can be referred to as a general practice clinic, a family medical practice, or a health centre. People usually turn here when having health problems – to the health care centre that is responsible for the area they live in, or the one they are registered with.
The health care centre deals with everything from regular checkups for newborns, to treating common diseases like tonsillitis, and chronic diseases. It also supplies advice to those who want to quit smoking or need help losing weight. If the doctor is of the opinion that a more specialised treatment is required, a referral is written to a specialist clinic at a hospital or another outpatient care clinic.
Health care centres have opening hours on weekdays for making an appointment by phone. Many health care centres also provide a drop-in service a few hours a week, where patients can come for immediate help without having to make an appointment. The health care centres also provide counselling over the telephone and can arrange home visits in certain cases.
Many health care centres and local hospitals have emergency receptions that patients can turn to when experiencing any acute symptoms even in the evening, on weekends, and in some cases at night. Making a prior appointment by phone is often required. In some parts of the country, emergency services are provided at the hospital emergency clinic instead.
Many different doctors at the health care centre
The doctors that work at the health care centre are mainly general practitioners. They may also called family practitioners or as family doctors. All general practitioners are specialised in the field of general medicine, and are experts in receiving patients with different symptoms and determining who needs treatment from another specialist or at the hospital. The general practitioners take charge of those stricken any of the general diseases, meaning the most common diseases in our society. They are responsible for treating patients with mild forms of any chronic disease, like for instance diabetes or heart failure. General practitioners can also help treating persons with mild or moderate depression. The idea is to enable patients to consult the same doctor for all sorts of ailments and establish a sense of continuity and safety - hence the term family doctor.
General practitioners also practice preventive healthcare, by helping people to change their ways of life, like quitting smoking, losing weight or improving their drinking habits.
General practitioners provide guidance within healthcare. They have a large network of contacts and know what other specialists are good at. Therefore, they can show patients the right way through healthcare, and write referrals to the right agency.
At the health care centre, just as at the hospitals, there might be doctors that are under training, called interns or residents. Interns are doctors that are completing their two-year mandatory medical internship post graduation. They usually work for six months in a health care centre, supervised by a general practitioner whom they can consult for advice.
Residents are doctors that are completing their specialist training. It is most common to encounter doctors specialising in general medicine at a health care centre, but they may also have another focus. Specialist training takes about five years to complete. The residents at the Healthcare Centre are regularly supervised by a general practitioner.
A third group of doctors that practice at health care centres are substitutes, filling in the gaps where there is a shortage of medical professionals. They can be specialists or not.
Choosing a health care centre
Beginning in 2010, patients are allowed to choose which health care or medical centre they want to belong to. The health care or medical centre of choice can be anywhere within their own county council or in an adjacent county council. They can choose between both private medical care centres and county council health care centres.
In some county councils, patients have the right to choose their own family practitioner. This is made by contacting the chosen health care centre. If the doctor of choice is not receiving new patients for the time being, you can choose another physician. Patients are allowed to choose a new family practitioner at any time.
Other health care professionals at the health care centre
There are variations throughout the country, but district nurses, nurses, physiotherapists, midwives and medical secretaries may also work at a health care centre. Occupational therapists, psychologists, counsellors and dieticians may also be found there. It is common for a health care centre to provide paediatric and maternal healthcare.
District nurses are nurses that have undergone further training. Their work consists of practical assignments like vaccination, handing out medication, and caring for wounds. The district nurses also work with preventing ill health, for instance by leading support groups for quitting smoking. They occasionally make home visits to patients who cannot visit the health care centre to get treatment or to have samples taken.
The district nurses often have their own consulting hours for people with certain chronic diseases, like diabetes or asthma. They handle a part of the treatment and are entitled to prescribe certain medications. When someone calls the health care centre for medical advice, it is usually the district nurse that answers and gives advice.
Nurses work along with the doctors and the district nurses. They draw blood for sampling, examine the heart through EKG and tend to wounds. At many health care centres, they also perform home visits. The nurses sometimes work at the health care centre reception desk. Medical secretaries, who in general handle administrative assignments at the health care centre, might also be seen working there.
Physiotherapists mainly work with people that suffer from ailments affecting mobility. They may be experiencing symptoms in the back or the neck, or they are rehabilitating from an injury or illnesses such as a stroke. The treatment can consist of advice regarding home exercise, relaxation and massage. The physiotherapists can prescribe physical exercise for prevention or alleviation of a disease. At some locations, patients can contact the physiotherapist directly; at others, it is necessary to have a referral from a doctor to get an appointment.
Occupational therapists help those who have a disease, or have been through and recovered from an accident, to get back into everyday life. They try out different aids and are experts in finding practical solutions for home and daily routines, like for instance adapting a home for a wheelchair.
Counsellors provide psychosocial support, like talking to people that are going through a crisis. Counsellors also provide patients with advice on how to handle finacial or work-related matters when being ill. Counsellors usually have a degree in social studies with additional experience in social work.
Psychologists can be found in health care centre at certain locations around the country. They have undergone five years of education at the university plus one year of obligatory practical training. They provide psychological treatment, and if trained within the field of psychotherapy, they can offer such treatments as well.
The services given at the Healthcare Centre are often limited, with the main purpose of enabling the patient to handle a difficult situation on his or her own in the future. The psychologist also assists the doctor with the psychological testing needed to investigate rehabilitation.
Both counsellors and psychologists can organise and lead group therapy sessions, like for example, stress management groups.
Dieticians specialise in nutrition. They offer advice to patients who need to lose weight or need to adjust their nutrition because of diseases like diabetes, and allergies.
Health care for specific problems
Some county councils have centres for substance abuse and dependency treatment, for example, youth clinics, and centres for paediatric and young adult psychiatry ( Barn och -ungdomspsykiatri, BUP). Staff specialised in these types of problems work there. Patients can contact the centres directly or get an appointment by referral from the health care centre.
Paediatric and Maternal Healthcare
Maternal health care centre
At the health care centres, or in connection to them, there often is a maternal health care centre (Mödravårdscentral, MVC) where midwives work. They can be consulted in questions regarding contraceptives and sexually transmitted diseases, or if you are pregnant. Most maternal health care centres arrange parenting groups and courses prior to birth. Midwives also take cell samples for detecting cervical cancer. Visiting the Maternal Healthcare Centre is free of charge, and patients can usually go to any centre of their choice.
Paediatric health care centre
The paediatric health care centre (Barnavårdscentralen, BVC) is usually also tied to the health care centre. The BVC is equipped with nurses specialised in paediatric care, district nurses and doctors. Paediatric nurses, who are nurses specialised in childcare, are sometimes also a part of the professional team at the BVC. The Paediatric Healthcare Centre conducts regular checkups on healthy children up to the age of six; after that, the children are helped by school health services. The BVC also provides vaccinations and advice regarding nursing, food and sleep. Parents of a sick child, regardless of age, go to the health care centre or the paediatric emergency clinic for help. The BVC usually provides a drop-in service, for getting help without having made an appointment.
There are psychologists connected to both paediatric and maternal health care.
Private care by agreement
Swedish health care can be administered by both the county council and by private companies that have an agreement with the county council. There are, for instance, private health care centres and private maternal health care centres. There is no difference between choosing one or the other, and the fees are the same.
Private care without agreement
There are also private caregivers that do not have an agreement with the county council. The patient is then obliged to pay all medical costs themselves. Private caregivers can be, for example, clinics that specialise in gynaecology, that offer a specific form of psychotherapy, or that perform cosmetic surgery. If you are not sure whether or not a clinic has an agreement with the county Council, it is easiest to ask how much the consultation will cost prior to visiting.
Specialised Medical Care
Medical specialist clinics
Emergency care hospitals mainly have medical specialist clinics, but local hospitals and private caregivers also provide specialised medical care. There, patients get to meet doctors that are specialised in other fields of medicine than general practice. In some cases patients can turn to them directly, and some hospitals, mainly in the large urban areas, have emergency clinics open on weekdays. In other cases a referral is needed from a doctor at the health care centre. Most of the times, the process is faster and costs less with the referral.
Different medical specialists
Medical specialists are doctors that have completed their residency, generally five years of training after having received the licence to practice medicine. There are doctors within a large range of specialities. The largest, apart from General Practice, are Internal Medicine, Surgery, Orthopaedic Medicine and Psychiatric Medicine.
Internal Medicine practitioners are experts in cardiology, gastroenterology, and respiratory medicine, to mention a few. They usually deal with diseases that do not require surgery, and are primarily treated with pharmaceuticals or by altering lifestyle habits.
Surgery is a field of specialisation where the surgeons primarily treat diseases of the internal organs by performing an operation. Examples of such diseases can be appendicitis, a hernia, or gallbladder and kidney stones.
Orthopaedists treat diseases in the musculoskeletal organs requiring surgery. It can be a broken leg, joint diseases, or herniated discs.
A psychiatrist takes care of people with psychological problems such as depression or schizophrenia, or of people who are dependent on alcohol or narcotics. Psychiatry and psychology are two very different professions. A psychiatrist is an authorised doctor that has completed a residency, specialising in psychiatry. A psychiatrist is entitled to prescribe medications. A Psychologist is not a licensed doctor, and has studied psychology at university. A psychologist investigates and treats, for example using psychotherapy.
Emergency Care Medicine
Emergency care clinics
Emergency care clinics are open 24 hours a day at emergency hospitals. This is where patients go to get treatment for conditions that are urgent, like sudden chest pain, a broken leg or severe bleeding. You can also go to the emergency care clinic if you are sick and the condition rapidly worsens. A doctor at the health care centre can make out a referral to the emergency care clinic if he judges that a patient is in acute need of treatment at the hospital.
Different healthcare professionals at the emergency care clinic
Nurses, staff nurses and doctors work at the emergency care clinic. Counsellors are also connected to the Clinic.
The nurses take samples, tend wounds, and make sure that patients are being taken care of in a satisfactory manner. The also work at the reception desk.
The staff nurses initially evaluate the condition of the patient, take samples and administer medication.
The counsellor mainly provides support to relatives in the case of a severe accident or in the case of death. They also provide support for patients that have been subjected to abuse or rape.
The receiving doctor at the emergency care clinic can be a medical specialist, but is usually a doctor undergoing education, either a resident or an intern. The medical specialists have many different responsibilities in the hospital and are generally not always at the emergency care clinic. There is, however, always at least one medical specialist connected to the Emergency Care Clinic whom the doctors on duty can call if they need any assistance. At university hospital emergency care clinics, patients might encounter medical students. They are at the hospital to learn, but are not responsible for treating patients.
The main responsibilities of the emergency physician are to assess how the patient is feeling, if he or she can be treated and then go back home, or if the patient will be hospitalised in any of the hospital wards for further treatment. There are often what are called observation locations at the hospital, where patients can remain for a couple of hours or until the next day, if the doctor wants to observe the course of events or if it is uncertain if the patient needs to be admitted for further treatment. Sometimes, follow-up treatment in outpatient care is necessary, normally at the health care centre or at the medical specialist clinic. The doctor then gives the patient a referral or writes directly to the doctor responsible for the follow-up treatment. Sometimes the patients themselves must contact their health care centre for follow-up.
Local hospitals are smaller hospitals, and do not always have an emergency care clinic that is open 24 hours a day. Doctors within many different medical specialities work here. Patients are treated in outpatient care, which means that they get to go home after the visit. They also have wards for admission, providing that the patient does not require the advanced hospital care available only at the Emergency Hospitals.