Perceptions of Care

Finland is covered by amazing – more than 100 000 – beautiful lakes that we all cherish. Many of us have summer lake-side cottages or can visit friends who own these wonderful small paradises. But not long time ago, our industries, especially the pulp and paper mills, together with the farms were about to pollute and destroy the best of the lakes and rivers with their poisonous and dirty spills. It was a natural outcome of irresponsible business and industrial management in 1950s and 1960s.

The environmental disaster was a perfect example on what can happen when the government does not interfere to protect its citizens and our environment, and when firms are free to choose what to do and how to behave. In a nutshell, national industrial strategy then was to let markets decide and choose the best way to operate. The outcome was a disaster.

Luckily, today, paper mills, as well as other industrial actors, have designed and built environmentally friendly systems, even making clean tech business out of it, but it did not come automatically. Citizen movements, environmental activists, and international pressure have made sustainable operations a must. Our lakes are now healthy, even in excellent condition. Had this freedom of choice been allowed to continue, our best lakes would have become disgusting, smelling pools of dirt.

You might think that this was a valuable lesson for our politicians. Far from that: our present government follows this devastating strategy today, but it does not dare to extend its market ideology to these familiar industries. Instead it has moved to softer areas of life, where it thinks there is less resistance.

This is a story of the terrible Finnish policy in something that is vitally important to all of us: our healthcare system.

Our government and its member parties are launching a new market freedom project by opening the healthcare services to private companies – and to competition, as it is nicely put. In doing this, the government and especially its right wing National Coalition Party (Kokoomus) tries to lure citizens to believe that medical business firms, if allowed to compete freely on the market, would behave better than their industrial predecessors and put their patient customers always first and above anything else – like money.

The promised, shining diamond in this conspiracy is to propose to us Finns that patients will be offered the freedom of choice, that is, they can choose which healthcare centers, doctors and care providers they want to use when in need. But this is a pure scam. It’s aimed at benfiting big healthcare companies, while our Center Party extends its reach over a new layer of regional governance, which has been conditionally linked with the healthcare “reform”.

The government uses the freedom of choice as lure. Nobody knows what exactly such a freedom would mean for us, the patients. The reform is complex because it involves the whole healthcare network and its organizational environment. It concerns everybody in Finland.

So, a personal story may help to understand what is so profoundly wrong and false in this kind of choice thinking. My observations are scary.

On the 18th of July, this summer, I was enjoying a delicious dinner with my wife, crepes with fresh strawberries, blackberries and raspberries, a sliver of cognac waiting in the glass. It was a typical beautiful summer evening, before the sunset on an island situated on Lake Saimaa, Luonteri, with clean, fresh water – pure untouched nature.

We have a small, cozy cottage, located some 40 kilometers from the nearest city, Mikkeli, where we often get our groceries. To get to this charming city from the island we take our small motor boat first and then drive by car the next 30 kilometers through the dusty, narrow forest roads before reaching the asphalted highways and the city area.

At about 8pm, I felt a sudden shaking in my left hand, which became slightly paralyzed and difficult to control, so much so, that I could not handle my fork. Having a background in neuropsychology and brain sciences, and extensive work experience as a young clinician, it was clear to me that this was serious. I was slightly relieved to notice that I did not have any other problems, like facial, balance, movement or speech disturbances. I stood up, cursed silently, wondering whether it was a stroke or a brain hemorrhage. I decided it was a mild stroke, took a sip of cognac, and said to my wife: “This is bad now, we have to hurry to the hospital and fast!”

She stood up, we left everything as it was in the cottage, made sure I have everything I needed, and started off with the motor boat, which I was still able to operate. I wasn’t afraid but every movement, like the manual starting of the small outboard motor, keeping balance and navigating the boat was not self-evident any longer. I knew that, at any moment, I could get a worse seizure, lose conscience, succumb to an extensive paralysis, or even die.

Still I chose to be the captain in the small boat since my wife was not used to operate its motor – and I felt relatively capable of doing it. Thinking about it now, it was not very rational choice behavior.

Reaching the shore and our car, it was clear it was too risky for me to drive, and my wife took the role of the rally-ambulance driver through the narrow forest roads, to get us safely, and as fast as possible, to the emergency clinic in Mikkeli Central Hospital. On the way, I called the emergency clinic asking for advice about where to go. I started having new symptoms, losing the feeling of touch in my left hand, fingers and arm. On my mind, I could visualize the position of the problem in the cerebral cortex, the stoke probably was causing damage.

According to the current government sweet promise –  the freedom of choice mantra – this was my precious moment of choice now. But never, not for a second did I think, which hospital or an emergency clinic should I choose. The nearest was the best now. In Finland, we have a uniform medical education system – it’s practically free, independent of the university where medical studies are offered and research conducted.  Hence, you can trust the overall quality of any hospital although there are differences in specialization, with some other differences, but all of them are equipped to save you where-ever you find yourself. Living in Finland, I did not need to think whether I have the right form of insurance, money or a credit card to cover the costs. I can go to any public hospital. Not for a second did I think whether this was the right place to go. I trusted they would take me in like any public hospital in Finland would do.

At the emergency clinic, I had to wait for five minutes before they put me on a hospital bed and a young doctor, let me call him Matti, specializing in neurology came to examine me. He had chosen the career as a neurologist and was now working in this public hospital – it was his personal choice in life and I was blessed to receive his professional care: I did not choose him. From the first moment, he attended to me carefully, listening to my vivid descriptions about the symptoms, some of which were rather peculiar. With my brain research background, I knew how to describe the symptoms. In this dangerous and even scary situation I was now free of the pressure of thinking about or making any choices and could assume my role as a patient, even with my better than average knowledge of the neurological symptoms and the threats and risks I knew.

Because of Matti’s caring attitude and his way of seriously listening to my experiences, I did not feel that I bothered the nurses when left alone. I called on and alerted them when new symptoms appeared. I was not alone, and I did not feel that I’m bothering them because now I knew I did it to inform them about my state, to help them understand what is happening in my brain and to help them help me.

The nurses were kind and caring and I could not stop thinking how and why they have chosen this profession, it would have felt lunacy to think that I have chosen them. During my 2-day stay at the Mikkeli hospital, and later in Helsinki, I had frequent discussions with these caring, professional nurses and learned about their commitment and views about their work. We had even fun sometimes. They had chosen to spend their life and education to choose us, their patients, other human beings, to care for us.

In the present governmental “freedom of choice” model, people are lured into the illusion that they should choose the doctors and nurses. In worst cases this might well be so, but when it comes to highly educated and committed professionals like we typically have in Finland, it is an illusion. Bad apples are another matter, everywhere, and we cannot plan our life based on them only.

In the current public health care system, it was natural for Matti, the neurologist in Mikkeli, to ask for a consultation from the University Hospital in Helsinki. After less than two hours from his inquiry, he received the diagnosis that I have an about 60% or more – if I remember correctly – block in my right carotid artery and I should be transported to Helsinki University Hospital as soon as possible for carotid surgery. I would be operated next morning. Matti never asked me whom I’d prefer he should contact, it was his choice and I trusted him. The cost was no issue. Later I would get the invoice for the two days, the TT-scan and other examinations at the Mikkeli hospital: about 90 euros.

As soon as the diagnosis was received I was transported in an ambulance to Helsinki. It was about 250 kilometers to Helsinki and I had a chance, lying on the bed, to interview the man who sat with me about their work, while his partner, a young woman was driving. It was a rather modern, well equipped ambulance but I was surprised to notice the poor quality suspension, and I was worried about how the vibrations might affect my brain – the clot in my carotid might send parts to my brain and cause a more severe stroke. As if to confirm my worried suspicions, I got some new, rather strong symptoms in my arm, but luckily, they disappeared. But I did think about what would happen if and when the investments in the ambulances, for example, become a part of the business game in the coming new healthcare model. Who would invest in the car suspension?

I was operated under local anaesthesia, lying on my right side and could follow the medical team – only listen to them because my head was covered in a small “tent”. A nurse held my left hand and we had a mutual, intimate code language by which I could answer to her questions by squeezing her hand once: yes, twice: no, and to show I still have power in my hand. I never saw her face. It was more than a communication code it was a code of care and presence. I could hear the team work, and sense the atmosphere of their high professionalism. I could even talk to them until my mouth became difficult to control, and the they just asked me to relax. I even tried to explain that I’m a specialist in designing the headrest they used to stabilize my head during the demanding operation. I used similar system in my own lab work, years ago in special vision studies that demanded careful stabilization of the subject’s head.

A wonderful thing happened during these moments, something I’ve experienced already before, in about ten different surgical operations I’ve gone through during the last 20 years, in public healthcare. I felt that I’m not only a patient of these devoted professionals, but I’m also their guest, sometimes even a member of the team, although with a peculiar, hopefully a silent role. Never have I felt that I’m their customer, never has it occurred to me that I could choose the team in the surgery or choose the other people, the cleaning ladies and the receptionists, the professionals who take care of me, directly or indirectly. I don’t know how they have seen me, but my guess is it’s more on the human than customer side, mostly.

I know that people have different, even bad experiences on how they have been received and treated in healthcare clinics – long queues, being ignored, and sometimes given false diagnosis or no diagnosis when serious illnesses have been neglected.  I do have ideas for improvement, too, especially how the follow-up is organized. I’d had a lot to say about that, but let it be for another time. But instead, think about the following and what our government is doing to these healthcare people:

Universities – including those where medical doctors are educated – have been under “organizational development” turmoil for more than ten years and the atmosphere there has suffered tremendously. Our Ministry of Education, and its background forces, have turned it into a disaster zone. Cancer researchers – I’ve heard it myself – are complaining about serious lack of proper research facilities and research money. Other scientists have the same story to tell. At the time of writing, the government has reserved tens of millions for its “strategic research” – that is, research that the politicians think would be nice for them to have. Our Prime Minister said today, 19th September 2017, that he was launching a plan for establishing a large institute, this time in economics, where our leading institutes of economics in Helsinki area will join forces and open the institutional heavens for our politicians. This is seriously ironic, since if in anything, Finland has failed in economics, under the guidance of our loud and media active economists during the last 20 years.

Politically this may be an innovative move, if the main politicians follow the pattern they have already shown, namely they will have a new institute and its stupid docents (“kaiken maailman dosentit” as our PM called the Finnish doctors and professors) to blame when have long summer holidays (another minister said in one a public speech). The nurses are made to suffer for unsustainable wage increases they received by calling them (“Sari the Nurse”), which is a pun in Finnish used to blame them for the cost of their salaries. Their salaries are relatively low here. Is this respectful to talk like this about these dedicated people who care for us in healthcare?

Our government is trying to fool us into thinking that we are the customers who will become ecstatic to receive better care, when we can choose the health professional, and why not even the janitors, receptionists and engineers in the hospitals, for our needs. This is not only a fraud, but a serious mistake. People are lured into forgetting what is critical: we need devoted people in the healthcare system, and its governance, who are ready to make the most crucial choice: the decision to invest their whole life for caring about us. They make the vital choice, not us, on a large national scale and meeting us when are at our weakest and in need for care and support. Their choice matters.

We will lose these people if the system, from educational to healthcare institutes, becomes sick. Who knows what will happen when patients are forced to behave like customers will doctors and other personnel naturally adopt the roles of businessmen and entrepreneurs?

Some may believe it will be good for us all. I don’t. We will see a new kind of degradation of the caring system if the educational institutes and the research conditions continue to suffer. This has happened because of the damage caused by our successive governments, by the arrogant blame that nurses are expensive, and by the continuous, politically motivated organizational games planned for our whole health- and social-care system.

If you have been unhappy with the treatment you’ve received now, think about the future when the current organizational conditions get worse. It’s not about the personnel, the people who want to care for us, it’s about the system that prevents good and devoted professionals from doing their best for us, to care.

I have now recovered and I’m getting back into shape again. I’ll never forget the numerous people, perhaps about 40-50 of them, who I met face to face, and the rest of them working in the background. They had chosen to care for me.

I’m sure some may think, reading this, that my free-market and “freedom of choice-thinking” brain centers have been badly damaged. I hope so.

Göte Nyman, Professor of Psychology, University of Helsinki, Finland
Columnist for FinnishNews;
His blog:
His almost latest book -“Perceptions of a Camino” (available from  Amazon & as Kindle)

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