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General Practice in Australia: a Swedish perspective.

From the snow to the vineyards, Dr Simon Hellström is a long way from his home in Uppsala, Sweden.

With logistical assistance from GPEx Deputy Director of Medical Education, Dr Simon Hay, Dr Hellström travelled to South Australia to experience life as a GP in a different environment – an experience that has opened his eyes to many differences between Sweden and Australia.

Although his career began working as a junior doctor in a psychiatric clinic, a forensic psychiatry ward and at the psychiatric Emergency Department, he felt general practice was a better career choice for him.

“I realised that I’m easily bored – or rather, understimulated – if my work gets too monotonous,” he said. “The GP field has just the right amount of unpredictability, surprises, challenges and mix of people that I like.”

With two short-term placements lined up in Clare and Tumby Bay, Simon travelled to Australia and immediately noticed some obvious differences between the GP training programs in Sweden and Australia. One difference is the shorter training time in Australia.

”We do five years of training, including about two years of additional hospital rotations. The local health authority is responsible for training enough registrar positions to supply future demands of GPs.”

Another big difference he noticed was the more structured way of following up registrar progression, with different assignments and assessments, the GP365, CKA and so on. ”You also need to do a final exam, which we don’t.”

There has also been a difference in the way Simon has delivered general practice, influenced by the change of landscape.

”The rural environment for GPs here is more challenging. We do have long distances between practices and hospitals up north in Sweden, but nowhere by far as vast,” he said.
”We usually see our patients for 20-30 minutes and not as often as you do.

“However, when we see our patients, more needs to be done. We never see patients just to write scripts. We also don’t take blood pressure or blood samples as nurses do that, unless we need to follow up clinical symptoms.”

In Sweden, GPs work closely and collaboratively with other in-house specialists such as physiotherapists, psychologists, counsellors and sometimes dieticians and diabetes nurses.

The practice also pays for all investigations and tests, “which means that we need to be really careful with what we order if the practice is to survive financially,” Simon said.

Patient records have largely been digitised in Sweden. All scripts are sent electronically to a national server, which enables the patient to retrieve it from any pharmacy in the country.

Most referrals are also sent electronically but the specialists will often reject the referrals if the GP has not completed their own sufficient primary investigations.

In Clare and Tumby Bay, Simon was inspired by the relaxed relationships in the doctors’ contact with the patients, something he wasn’t used to: in Sweden doctors are much keener to maintain a strict line between professional and private.

”I guess in part that may be because they are smaller communities where you inevitably come to get to know people, but also because you see your patients more often,” he said.

Simon also liked the Australian view on work-leisure balance (which means that people are not too tired at the end of the day for doing things spontaneously); the morning meetings with a common ward round of all the doctors; the idea of an efficient Skin Clinic – and of course, tasting South Australian wine!

There were some challenges for Simon, such as the billing system that does not exist in that way in Sweden.

”I don’t like to think about money when I work!”

Australian GPs also have different approaches to certain medical problems that were completely new to Simon, such as giving steroid injections for sciatic pain and referring for ultrasound guided shoulder injections. ”I would simply inject them subacromially on the spot,” he said.

He noticed that accessibility to psychological treatments is limited and that Australian doctors are much more generous with prescribing broader-spectrum antibiotics.
If a permanent move to Australia was ever in Simon’s future, there is one area where he feels he would need to develop his skills further.

”A genuine medical challenge if I were to practise here would be the obstetrics.

In Sweden, GPs generally don’t deal with any of that as midwives run the antenatal clinics,”

Another surprise was that Australian doctors wear their own personal clothes to work. In Sweden, doctors are required to wear freshly cleaned work uniforms that are supplied by their employer. Long sleeves, watches and jewellery are strictly forbidden while at work.

”It’s difficult to not gasp a little when you see someone dip their sleeve into the open wound!”

For anyone thinking of undertaking a GP placement in South Australia, Simon recommends planning early as there is a lot to consider and building the necessary networks takes time.
He also recommends taking a leap and trying to start some consults on your own, with a local GP behind you.

“People are extremely welcoming, helpful and hospitable,” he said, “things will generally work out well!”

And in rural practice, “Don’t wear warm shoes while working!”

When he returns to Sweden, he will make some changes based on what he has learned during his time in Australia.

These changes will include not being afraid to be a little more personal with patients, splitting long consultations into multiple appointments rather than finding all the solutions at once, exploring the possibility of starting a skin clinic and making an effort to socialise with colleagues outside of business hours.

Thank you to all the South Australians I have met. It has been an overwhelming experience and I will definitely speak well of you when I get back home! A special thank you to Dr Simon Hay of GPEx who helped me arrange things from the start.
Dr Simon Hellström

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