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.”

Health Minister Pushes for Swift Regulations of Cosmetic Fillers

The Minister of Health, Willum Þór Þórsson, is pushing for regulations on the use of fillers in Iceland following concerns raised by the news programme Kompás. While the exact timeline remains uncertain, the Minister aims to have the regulations established this year, Vísir reports.

Hopes to implement regulations this year

The Minister of Health, Willum Þór Þórsson, is taking steps to implement regulations on the use of fillers in Iceland, aiming for clear restrictions by this year. This move comes after the investigative news programme Kompás highlighted the risks associated with the current lack of regulations on who can administer fillers.

As noted by Vísir, doctors have long advocated for such regulations, but their calls have gone unanswered. Yesterday, Minister Þórsson acknowledged the urgency, stating, “I have instructed the ministry to promptly utilise the regulatory authority found in the Medical Devices Act, alongside looking into the Health Professionals Act. The Directorate of Health would then oversee this, determining who is authorised to use these substances and ensuring they have the necessary expertise. That’s what’s missing.”

“Simultaneously,” the Minister added, “I’ve requested that we look at comprehensive legislation, similar to Sweden’s approach, though it might take longer.”

When asked about the specifics, the Minister couldn’t provide an exact date but emphasised the need for swift action. He hopes the regulations will be in place this year.

Experts Alarmed by Surge in Daily Drinking Rates

bar beer alcohol

According to a physician at the National Centre of Addiction Medicine (SÁÁ), the surge in online alcohol sales poses a concern for public health. Over the past four decades, the daily alcohol consumption rates among patients admitted to the Vogur Detox Centre and Rehabilitation Hospital with alcohol-related issues has more than tripled, Vísir reports.

Improved access, increased consumption

At a Nordic conference on alcohol and public health held yesterday, the impact of increased access to alcohol on consumption rates was a focal point of discussion.

In his opening remarks, Health Minister Willum Þór Þórsson expressed concerns over the rising levels of alcohol consumption, emphasising the irrefutable evidence that greater accessibility leads to higher usage rates. “Undeniably, better access results in increased consumption. This is an empirical fact that we must acknowledge and confront, particularly in our preventive efforts,” Minister Willum asserted.

Daily alcohol consumption on the rise

Lára G. Sigurðardóttir, a physician at the National Centre of Addiction Medicine (SÁÁ), echoed the minister’s sentiments in an interview with Vísir. She highlighted statistics that indicate a significant surge in daily alcohol consumption.

Read More: IR speaks to Dr. Lára Sigurðardóttir about nicotine pouches

Data from the Vogur Detox Centre and Rehabilitation Hospital reveals that around 1990, approximately 17% of patients admitted for alcohol-related issues consumed alcohol daily. Fast forward to last year, and that figure has skyrocketed to 66%. “Moreover, over 70% of patients aged 50 and above are daily alcohol consumers. The trend is particularly pronounced among older demographics,” Dr. Lára noted.

Dr. Lára also expressed concerns over legislative pressures to privatise alcohol sales, a move she and other experts warn could exacerbate the issue. “That’s the alarm that all the experts today have been sounding,” she added, noting that the online sale of alcohol has greatly increased public access.

In conclusion, Dr. Lára advocated for the retention of a state monopoly on alcohol sales, citing its proven efficacy in preventive measures. “A state monopoly remains the most effective sales model for mitigating the public health risks associated with alcohol consumption,” she stated.

This article was updated at 08:56

Risk of Overdose Rises Following Closure of Iceland’s Only Safe Injection Site

Iceland’s only safe injection site, a temporary project operated by the Icelandic Red Cross, shuttered on March 6. A Red Cross employee told RÚV such sites decrease the risk of overdose among intravenous drug users in addition to saving funding within the healthcare and social service system. Over 100 individuals used the safe injection site within the last year, many of them unhoused, during over 1,200 visits.

Ylja, as the safe injection site was called, opened in May of last year and was a temporary pilot project operated by the Icelandic Red Cross. Like safe injection sites abroad, Ylja offered a safe environment for those 18 years of age and older to inject intravenous drugs under the supervision of trained nurses, who ensured sanitation, safety, and infection prevention practices were followed. Safe injection sites are a harm reduction service that can prevent overdose and death among users of intravenous drugs. They can also connect clients to other essential services they may require.

Assists a marginalised group and saves public funds

“We need housing and the funding to pay for it, in order to operate a safe injection site. There is a lack of political will to approve it,” stated Marín Þórsdóttir, the department head of the Icelandic Red Cross’ capital area department. In 2015 and 2022, the Icelandic parliament shelved bills to decriminalise drug possession for personal use. Minister of Health Willum Þór Þórsson promised to submit a new, revised bill last autumn but has yet to do so.

Marín adds that with Ylja’s closure, the Red Cross loses staff that is specialised in harm reduction, primarily nurses. While operating a safe injection site requires considerable funding, Marín says it ultimately saves public funds. “We are tending to a very marginalised group that receives little service, experiences perpetual discrimination in society, and it’s just savings, both within our healthcare and social services system by having a safe injection site and assisting people with harm reduction resources.”

Read more: In Harm’s Way

Economic and social factors appear to impact drug use in Iceland, according to the research of Dr. Arndís Sue-Ching Löve, an assistant professor at the University of Iceland. Her studies show that cocaine use decreased in Iceland during the COVID-19 pandemic, but increased again last year to around pre-pandemic levels. The increase may be partially explained by increased prosperity: a similar pattern was seen before the banking collapse in Iceland.

Orthopedist: Surgical Waiting Lists for Children “Unacceptable”

Press photo of the year 2020

An orthopedist at Landspítalinn hospital has told the Minister of Health that surgical waiting lists for children are unacceptable. “I can’t get them into surgery within an acceptable time frame,” Sigurveig Pétursdóttir told Willum Þór Þórsson during an annual meeting of the Icelandic Medical Association in October.

“I’m on my knees”

Sigurveig Pétursdóttir, 64, has been employed as a doctor for 38 years. She’s spent 30 years working with disabled children as a paediatric orthopedist. At an annual meeting of the Icelandic Medical Association, held on October 14, Sigurveig told Minister of Health Willum Þór Þórsson that the state of the hospital “has never been worse.”

Read More: Mass Resignations at the University Hospital

“I’ve got children who’ve waited a year,” she called out from the assembly hall, according to a transcript of the meeting published by the Icelandic Medical Journal: “A disabled child who walks with one leg crooked for an entire year because there’s no space in the operating room. And why is there no space? Well, because the staff has quit. It’s not a matter of not having the staff. They quit. The hospital’s a mess. It’s a mess right now. It’s not going to become a mess tomorrow. It didn’t happen yesterday.”

Sigurveig preempted familiar bureaucratic talking points with the statement that all talk of analysis and assessment was unacceptable: “I’ve heard it a hundred times, but the situation has never been worse than now,” she stated. “It means nothing to me, being told that I did so well during the pandemic, not having missed a day of work.”

“I’m on my knees,” she continued. “I’m giving up, and I’m not the kind of person who gives up when things get rough. But no one will be able to walk in my shoes. No one!”

Increased funding required

Those present at the annual meeting urged the government to heed the will of the public and to increase healthcare funding. They also announced their disappointment in next year’s budget bill, urged healthcare institutions to ensure the safety of their staff, and called for actions to be taken to deal with the failing health of doctors and the growing number of healthcare professionals who are resigning from their jobs.

In late October, sixteen middle managers employed at the National University Hospital of Iceland received letters of termination. The terminations stemmed from the adoption of a new organisational chart intended to improve the hospital’s operations.

“The main purpose is to get a handle on the hospital’s management and operations, to strengthen our clinical services, and to harmonise other key services,” Runólfur remarked in an interview with RÚV.

Plans to Raise Mandatory Retirement Age for Healthcare Staff to 75

Iceland’s Health Minister Willum Þór Þórsson wants to speed up plans to raise the mandatory retirement age for healthcare workers to 75, RÚV reports. Public employees may not work past the age of 70 according to current regulations. Willum has stated that the move is intended to help relieve staffing issues that plague Iceland’s healthcare system, though more needs to be done.

If the regulations are amended, healthcare workers will still be dismissed upon reaching the age of 70, but would be eligible to be rehired on a new employment contract until the age of 75. Willum stated that such employees may be subject to a skills assessment.

Read More: Chairman of Medical Association Warns of Doctor Shortage

The Health Minister stated that although raising the mandatory retirement age would hopefully relieve staffing issues, it would still be necessary to make various medical professions more accessible to young people and improve recruitment across the field.

Nicotine Products to Be Banned in Schools

A new parliamentary bill by Minister of Health Willum Þór Þórsson recommends the addition of nicotine products (including nicotine pouches) to a law on e-cigarettes and e-liquids, Vísir reports. The aim of the bill is to decrease the use of nicotine pouches by children and young adults.

Flavours appealing to children to be banned

In a new parliamentary bill, Minister of Health Willum Þór Þórsson proposes an amendment to Act No. 87/2018 on Electronic Cigarettes and Refill Containers for Electronic Cigarettes. Among changes to the legislation is a ban on the import, manufacture, and sale of nicotine products and e-cigarettes containing flavours that may appeal to children (such as candy and fruit).

According to a report appended to the bill, the purpose of the ban is to decrease the use of nicotine products among children and young adults: research has shown that flavouring, especially fruit and candy, play a significant role in the popularity of e-cigarettes among children and young adults.

“It is logical to assume that the same holds for the popularity of nicotine pouches,” the report notes.

Banning nicotine products in educational institutions

The new bill also proposes a ban on the sale of nicotine products in preschools, elementary schools, junior colleges, and other educational facilities associated with sports, daycare, recreation, and social events for children and young adults. Universities are not included on the list.

The bill places particular emphasis on educating children and young adults within elementary and junior colleges on the risks associated with the use of e-cigarettes and nicotine products; and on educating responsible parties in pedagogy, education, and healthcare.

Iceland to Lift All COVID Restrictions Next Week

On February 25, Iceland’s authorities plan to lift all remaining domestic restrictions due to COVID-19, the country’s Health Minister Willum Þór Þórsson has stated. This includes isolation for those who test positive for COVID-19, though those who are sick will still be encouraged to stay at home. Iceland’s National University Hospital continues to experience strain, particularly due to staff shortages caused by COVID illness.

Iceland reported 2,489 new domestic cases of COVID-19 yesterday, a national record. The number of patients in hospital with COVID-19 is 54, with 3 currently receiving intensive care. As of this morning, 363 hospital staff members were in isolation due to COVID infection, a record for the hospital. Willum says authorities are considering lifting isolation requirements for hospital staff that is symptom-free. Iceland’s current domestic restrictions include a 200-person gathering limit and mask use when distancing cannot be ensured.

Responsibility shifts to individuals

Barring any unexpected changes, Willum says authorities plan to lift all remaining domestic restrictions on February 25, or Friday next week. This includes requiring those who are COVID-19 positive to isolate. “But then it’s important to remember, that just like in general when people get sick, you need to get better and be careful. The more we lift restrictions the more we appeal to the individual’s responsibility to take care of their health.

COVID-19 services transferred to local healthcare centres

COVID-19 healthcare services are also undergoing sweeping changes in Iceland. As of today, primary healthcare centres will take over most COVID-19 services and monitoring of COVID-19 patients, previously done by the National University Hospital’s COVID-19 ward. Individuals who are seriously ill due to COVID-19 and those in high-risk groups will still be serviced by the National University Hospital, however. Vaccination, which for capital area residents has been administered in a mass-vaccination centre set up in Laugardalshöll stadium, will also be moved to primary healthcare centres in two weeks.

COVID-19 Isolation to Shorten to Five Days

Iceland’s Health Minister Willum Þór Þórsson announced to media today that mandatory isolation for COVID-19 positive individuals will be shortened from seven days to five. Willum made the announcement in a radio interview this morning. The new regulations are to take effect this Monday, February 7.

“The illness varies among people so people must of course show caution and take care of themselves,” Willum stated, underlining that patients must be symptom-free to be discharged from isolation. Asked when mask regulations would be lifted, Willum stated: “I think that’s coming soon, everything is on our side.”

Icelandic authorities announced a plan to lift all domestic COVID-19 restrictions by mid-March, including isolation and quarantine due to COVID-19. The country has been reporting around 1,500 daily cases in recent weeks – nevertheless, the number of patients in hospital due to COVID-19 has dropped over the past week. Local data shows that around 90% of COVID-19 cases in Iceland are due to the Omicron strain, which has lower rates of hospitalisation and serious illness than the Delta strain of SARS-CoV-2. Isolation was shortened from 10 days to 7 in December of last year and quarantine regulations were significantly relaxed in January.

Quarantine Regulations Eased for Vaxxed and Boosted Individuals

Minister of Health Willum Þór Þórsson

Quarantine regulations will be eased for individuals who have both been fully vaccinated and received a booster, as well as for fully vaccinated people who have recovered from a previously confirmed COVID infection. The changes were announced by Minister of Health Willum Þór Þórsson on Friday on the government’s website.

Willum Þór made the decision to loosen regulations on the recommendation of Chief Epidemiologist Þórólfur Guðnason, who cited research from the UK and Denmark that indicates that fully vaccinated and boosted individuals are much less likely to become infected with COVID, particularly the delta strain. The research shows that boosted individuals are also less susceptible to omicron infection, although vaccination has been shown to be less effective against omicron than delta.

The new quarantine regulations for boosted and fully vaccinated/previously infected individuals will go into effect immediately.

It is hoped that the easing of quarantine regulations will make a significant impact in boosting the economy and making day-to-day life easier in Iceland, where around 160,000 people—roughly 43% of the population—has received a COVID 19 booster.

“We need to keep society going as much as possible,” said Willum Þór, “whether we’re looking at schools, welfare services, or various economic activities. As it stands now, this response is absolutely necessary.”

Per the announcement on the government’s website, qualifying individuals who are otherwise subject to quarantine are now:

  • permitted to go to work and/or seek out necessary services, such as health services, as well as go to grocery stores and pharmacies, and use public transportation
  • not permitted to attend gatherings or locations where there are 20 or more people present except in the specific instances mentioned above
  • required to wear a mask when in the company of anyone except their closest contacts (i.e. family or people they live with); masks are required even when a distance of two metres is observed
  • not permitted to visit healthcare institutions such as nursing homes without special permission from the institution in question
  • required to avoid contact with persons who have a high risk of serious illness if they contract COVID-19

Qualifying individuals are expected to observe quarantine under the above protocols for five days; their quarantine ends on Day 5, provided that they receive a negative result on a PCR test. Individuals who notice symptoms of COVID during their five-day quarantine are urged to get a PCR test without delay. Quarantine remains a minimum of five days.