Monday, September 06, 2021

End of being micromanaged

Some time ago, I made the biggest financial investment hitherto in my life. Much more than the double of what I have paid for my house. It is a bold move, but I believe that it is the correct one. Apparently the bank and accountancy concur. Starting October 1st this year, I will run my own neurology practice. I hope that I will be able to provide good consultations and the necessary continuity for the patients left out of the secondary sector, and as a silver lining I hope to be able to get back a good quality of life. I am turning forty this year and I am a father of three, and irregular shifts including seventeen-hours long night turns without rest combined with weekend work is not that tempting anymore. I am intent on becoming my own leader again, get some freedom back and run a good proprietorship serving the patients stricken by neurological manifestations.

Twenty years ago this autumn, just after 9/11, while I was crossing Canada and the United States back and forth in a Greyhound bus, I made the decision to actually go ahead and attempt getting into Medical School. I recall the meditative disposition I was in and even which book I was reading as the landscape and days shifted outside. When back in Lund I wrapped up my Philosophy and Cognitive Science studies as I worked evenings driving a forklift. I started out my medical studies in Umeå and finished them off in Odense, and the rest is history. With a few detours, the Department of Neurology at Odense University Hospital has been my home base. For the past twelve years, it is where I have returned to, and I am aware of all the internal anecdotes of the unit, which in itself could become an amusing narrative.

Albeit a great place, the situation for neurology in the Funen and archipelago region is not. Those who know me have heard me many a time muttering over how a department can keep taking on more tasks despite not having more staff and having fewer hospital beds, which is a process that has been ongoing for the entire time I have been there. Neurology has moved so much the past decade. Partly, which is very time-consuming, in the cerebrovascular field with new treatment and intervention possibilities for acute stroke patients. In fact we are now in a similar situation to the one cardiologists were in back in the 1980s when PCI was introduced for the coronary arteries. Back then however, a national plan was laid out, creating realistic infrastructure for handling this - not so much these days. Overall these news are good though, patients from all over the Region of Southern Denmark are flown into Odense to get acute treatment for a brain clot that would otherwise have rendered them paretic and without a language, or worse.

On Funen we only have one neurology department, one department! Twenty years ago, at least six departments on Funen handled patients with apoplexy. Back then, nothing acute could be done - it was prophylactic treatment and neurorehabilitation. Heavy patients to be frank, but a shared burden. This new paradigm regards stroke patients, but what about the other patients, the part of neurology that is not cerebrovascular? Neurology is also striding forward in other areas, e.g. with novel treatment options for MS and other neuroimmunological diseases, giving these patients a much better working life than before.

With high specialization and more treatment offers for the acute, what happens to all the non-emergency patients? What happens to general neurology? Exactly what you may think: People with Parkinson's and other movement disorders, epilepsy, neuropathy, etc., need to wait in line. There is no stability for them. And much less so on Funen, as they need to compete not only with the mentioned acute cerebrovascular patients but also with the ones receiving second opinion from the peripheral hospitals in the region. That is right, Funen does have one department of neurology, but it is also the university hospital for the entire Region of Southern Denmark. As a consequence, the pressure on the attending neurologist increases, as the Funen GPs (rightly) need assistance with their patients, and the waiting list for the outpatient clinic increases because of a bigger demand on the acute side. 

Has this been said many times, year after year? Have many good colleagues left because of an untenable situation? Has the constant centralization come with anything but additional layers of disruptive greasepaint created by an ever-increasing bureaucratic burden? Is this news? 

The answers are Yes, Yes and No, No

As the spiral keeps going in the wrong direction and I by no means believe that the public leaders or middle management are fitted with the right tools to fix these things, I could go bitter and cling on to the position I have achieved. Accept disillusionment and stay a zombie until I retire, learning to love being constantly micromanaged by bureaucrats. I would rather not, though. No more ill-fitting scrubs for me.

Over and out.