Iceland’s Doctors Drowning in Paperwork

Iceland’s Minister of Health will meet with the chair of the Icelandic Association of Family Doctors to discuss doctors’ criticism of excessive paperwork cutting into their time with patients. Doctors sent the Minister a list of demands last month and have now been invited to a meeting tomorrow.

“This means of course that the minister is listening to what we are asking of him,” Margrét Ólafía Tómasdóttir told RÚV, though she said she is keeping her expectations in check. “We’ve previously gotten to speak with the minister about these issues back and forth without anything changing.”

Preventing doctor burnout urgent

Margrét says doctors have been discussing the issue of excessive paperwork, particularly referrals, that are required within the healthcare system since 2016, but no administrative changes have been made. “It is clear that it’s first and foremost the paperwork that is wearing down doctors, not interaction with patients.”

Margrét says doctors want to eliminate all referrals and paperwork that “does not involve a true doctors’ professional assessment.” Doctors in Iceland are often required to write referrals for patients so they can see other healthcare professionals such as physiotherapists, speech pathologists, and others, or so that their appointments with specialists are covered by health insurance.

System demands referrals and certificates

GP Indriði Einar Reynisson recently wrote about the various certificates and referrals he is regularly asked to provide in a public Facebook post. Indriði stated that schools and workplaces sometimes require multiple doctor’s certificates from students and employees for the same illness. He also stated that the Social Insurance Administration (Tryggingastofnun, or TR) often required patients to send renewed doctor’s certificates every two months, although their situation was unchanged. In the case of one disabled patient, Indriði was required to send separate certificates confirming the patients’ status to over six different institutions.

Iceland Review has regularly reported on Iceland’s shortage of doctors as well as other healthcare professionals. Margrét says that patient interactions are what provide doctors with fulfilment on the job, “But when the majority of the working day becomes meaningless paperwork where your professional knowledge doesn’t get to be used, it must burn you out and cause people to leave the profession.”

Icelandic Doctors and Nurses Sign Ceasefire Petitions

Nurses Hospital Landsspítalinn við Hringbraut

Over 400 Icelandic doctors have signed a petition calling on the Icelandic government to denounce Israel for its attacks on Gaza and demand an immediate ceasefire, mbl.is reports. A separate letter from Icelandic nurses with the same demands has 254 signatures, RÚV reports. The letter outlines the deaths and destruction of infrastructure caused by Israel’s attacks in Gaza and call the situation a humanitarian crisis.

“In the past few weeks, Israel has carried out extensive attacks on Gaza in revenge for a terrorist attack which was carried out in Israel. Israel’s attacks have killed at least 10,569 Palestinians, including at least 4,324 children. The attacks have also caused tremendous destruction of Palestine’s infrastructure, which is at the point of collapse. Israel has cut off all water, electricity, and food supplies to residents of Gaza and is significantly restricting all aid from Egypt. A serious humanitarian crisis is happening that must be responded to as quickly as possible,” the opening of the letter from Icelandic doctors reads.

Demand Icelandic government puts pressure on Israel

The letter outlines the impact of the attacks on healthcare services in Gaza, including the killing of healthcare staff, destruction of hospitals, clinics, and ambulances. “The healthcare system in Gaza collapsed a long time ago,” it reads, in part. “Hospitals in Gaza cannot fulfill their role.”

“We the undersigned send this letter with the sincere wish and demand that the Icelandic government responds to the serious events that are now happening and demands a ceasefire,” the letter continues. “The government should put pressure on Israel to stop the continuing attacks on innocent residents of Gaza and on healthcare services in the area and condemn [Israel’s] actions.”

Locals in Iceland have held regular protests calling on the government to denounce Israel’s attacks and pressure for a ceasefire. A protest in support of a ceasefire will be held outside the US Embassy in Reykjavík today at 5:00 PM.

Iceland’s Proposed Legislation Contradicts Code of Ethics, Doctors Say

Dómsmálaráðherra Ríkisstjórn Alþingi Jón Gunarsson

 Doctors in Iceland will be forced to choose between obeying the law or obeying their international code of ethics if the government passes its proposed amendments to the Immigration Act, the chairperson of the Icelandic Medical Association stated in an interview with RÚV. The proposed legislation would grant Icelandic police the authority to force physical examinations on asylum seekers. The legislation was introduced by Minister of Justice Jón Gunnarsson and has been criticised by human rights organisations in Iceland.

Forced testing, physical examination, and handing over of medical records

“In this 19th article, as it is worded, the police are given very broad powers to force people to undergo various interventions: testing, physical examination, and more. And also to hand over medical records, which are sensitive, confidential information. This completely contradicts doctors’ code of ethics,” Steinunn Þórðardóttir, chair of the Icelandic Medical Association stated.

“The World Medical Association’s Declaration of Geneva [the modern-day Hippocratic Oath] reads as follows: the health and well-being of my patient will be my first consideration. We wonder how these two things can go together and actually see it as a complete impossibility. If this becomes law, we are put in the position of having to choose between complying with national law or the international code of ethics for doctors,” Steinunn remarked.

Doctors would need to believe deportation is in patient’s best interest

The Association’s formal comments on the proposed legislation strongly criticise the proposed changes. “If a foreigner that is set to be deported is forced to undergo such examination, it can be assumed the person is opposed to being deported. Individuals in this position tend to have complex issues, often due to post-traumatic stress, and are being deported back to situations where they consider their life and health to be at risk. By issuing the aforementioned certificate, a doctor would need to consider that such deportation from the country would be in the best interest of the person in question, according to the aforementioned code of ethics,” the comments read.

The comments continue: “Respect for the patient and mutual trust are the basis of medical practice. An action such as [forcing physical examination] works against patients’ interests and human rights, and we consider it to be in conflict with the United Nations Declaration of Human Rights.”

Doctor’s Orders

Þórólfur Guðnason

Over the past 18 months, Þórólfur Guðnason has gone from quasi-anonymous medicine man to bona fide historical figure. Along with Director of Health Alma Möller and Director of Civil Protection and Emergency Management Víðir Reynisson, Þórólfur forms the so-called “troika” – the face of the government’s response to COVID-19. He’s Iceland’s Anthony Fauci: the imperturbable voice of reason and restraint. It’s a complicated role predicated mainly on credibility, demanding a certain immaculateness when it comes to personal precautionary measures.

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Emergency Ward Staff Shortage Puts Patients at Risk

emergency department hospital

Management at the National University Hospital of Iceland is working to address the doctor and nurse shortage at the hospital’s emergency ward, RÚV reports. This summer 500 shifts at the ward are expected to have a shortage of nurses and four doctors at the ward have resigned so far this year. While staff has been vocal about conditions at the ward for years, Director of the Emergency Doctors’ Association Bergur Stefánsson says staffing issues have never been worse.

Bergur says Iceland’s Director of Health has sent around five reports and memoranda to the Minister of Health since 2018 addressing the emergency department’s issues. Despite those communications, “The situation has definitely not improved.” He adds that staffing issues among physicians have never been worse and if conditions at the ward do not improve, it will be impossible to ensure patients’ safety. “And with that, we are putting them at risk.”

Partial Audit Gave Ward a Failing Grade

In 2019, a partial audit published by the Directorate of Health found neither lodging nor staffing conditions at the emergency ward fulfilled regulations and that the ward could not ensure patients’ rights regarding care. “Now it has come to pass that the problem is of such magnitude that we cannot let these conditions go on,” the audit stated. “It can create grounds for unexpected incidents and the risk of additional staff dropout.”

National Hospital representatives have stated they are working to address the expected summer staff shortage as quickly as possible. The 2019 audit however stated that fully addressing the ward’s issues would require broader support from authorities. Bergur says emergency doctors have requested a meeting with the Minister of Health and the Parliamentary Welfare Committee, but have been rejected. “We need real action to be taken, real improvements.”

National Hospital Needs Additional ISK 1 Billion for Wage Hikes

Emergency room

The National Hospital of Iceland needs ISK 1 billion ($8m/€7.2m) in additional government funding to pay out salaries decided upon in previous wage agreements, RÚV reports. The Parliamentary Budget Committee is discussing how to address the issue. If more funding isn’t provided, say hospital representatives, it will be necessary to cut services or run the hospital with a deficit.

Ebba Margrét Magnúsdóttir, chairperson of the hospital’s doctors’ council, says the government undercalculated the hospital’s funding following the signing of recent wage agreements. According to information from the hospital, an additional ISK 500 million ($4m/€3.6m) in funding is needed per year to pay out wage increases laid out in doctors’ 2017 collective agreement. Double that amount is needed to address agreed-upon wage increases of all medical staff at the hospital.

Restructuring

Minister of Health Svandís Svavarsdóttir stated that although ensuring healthcare funding over the long term is important, “we also need to organise it better,” and suggested the government’s new health care policy would play a part in addressing funding.

The National Hospital of Iceland has already undergone significant restructuring in order to address its operational deficit. Directorial positions at the hospital have been reduced, and nurses’ and midwifes’ shift premiums have been cut. According to Ebba, however, these are measures the hospital shouldn’t have to take. “The people on the floor have pretty much had enough,” she stated.

Increased Antibiotic Use a Concern, Says Health Directorate

Antibiotic use among Icelanders increased by a little over 3% last year as compared to the year before, Kjarninn reports. The Directorate of Heath’s annual report on “Antibiotic Use and Antibiotic Receptivity in People and Animals in Iceland” did find, however, that Iceland’s use of antibiotics on animals is among the lowest in Europe.

The Directorate expressed a certain disappointment over the finding that Icelandic antibiotic use has gone up, particularly given that over the same time period, it’s gone down for people in other Nordic countries. It was found that antibiotic use has consistently been highest among patients aged 65 and older, followed by children aged five and under. Antibiotic use among the youngest patients did actually reduce between 2016 and 2017, and yet, when compared with previous years, antibiotic use among children was still on the rise during 2016. Antibiotic use among patients 65 and older has not experienced any such dips, but simply steadily increased over the years.

Antibiotic resistance is still relatively low in Iceland when compared to its neighboring countries. This has remained largely unchanged since 2016.

In April 2017, a working group under the supervision of the Health Minister submitted a report that outlined ten recommendations for fighting the spread of antibiotic resistance. These included recommendations on reducing the use of antibiotics among people, as well as monitoring antibiotic resistance in bacteria found in both foreign and domestic foodstuffs.

In 2018, efforts were made to increase awareness among doctors about the risks of over-prescribing antibiotics. The Directorate of Health hopes that this will lead to doctors reducing the amount of antibiotics prescribed to patients. Per the recommendation of the working group, foodstuffs also started to be monitored for antibiotic-resistant bacteria and research began on antibiotic resistance in general.

“Hopefully, all of these factors will prove useful in combating the spread of antibiotic resistance which is considered to be one of the most pressing health threats of our time,” concluded the Directorate of Health.