Week 1: "You are very welcome to Sweden!" - Part II

My first impressions/experiences at the hospital deserve their own blog. Jenn and Mags - you might be the most appreciative of these things since you know how things work in the US as a med student. I am doing two x 4-week rotations while in Stockholm, both at the large public hospital Södersjukhuset which is directly across the street from my dorm and actually connected to my dorm via an underground tunnel meaning that when it is dark and cold and rainy/snowy, I don’t actually ever have to go outside (well, except for grocery shopping and to maintain my sanity of course although the days are getting noticeably shorter and shorter...) I have met a few fellow medical students living in my dorm. Edith - from Austria - is currently starting an orthopaedic surgery rotation at Södersjukhuset, Almudena - from Spain - just finished internal medicine at KI-Solna and is now on general surgery with me at Södersjukhuset, and Kenneth and Anthony both from Makerere University in Kampala, Uganda who are also on general surgery with me at Södersjukhuset. Our first week was spent on anesthesia and we met the anesthesiologist in charge of international students (Åsa) at 830 on Monday morning. Like most of the Swedes I have since met, Åsa’s English is very good although she does have some difficulty finding words occasionally of which I have picked up the habit of finishing sentences. Here, that seems to be appreciated, but I’m going to have to be careful when I get back that I don’t continue to do that. One of the cute/quirky things I have noticed when speaking with people and telling them this is my first time in Sweden, is that they say “You are very welcome to Sweden!” I’m not just welcome, I am very welcome. People here are polite and the physicians seem genuinely glad to take on students, especially international ones. 

We started our first day by going and getting the mandatory hospital apparel. I had been somewhat prepared for what to expect by an essay written by a previous University of Minnesota medical student who was in Stockholm this past spring on an ENT rotation but nothing could really prepare me for seeing myself in the scrubs that we were provided with. The blue color was the same as we use in the States (although they also have white, gray, and green scrubs - not sure what those mean yet) but the scrubs themselves were like something straight out of the 80s. First off, there are pockets everywhere which is kind of handy especially since we haven’t been wearing white coats (I was told not to bring mine, so I don’t know if we will ever be wearing them). But the scrubs have cuffed ankles, a cuffed waistline on the shirt, and cuffed, puffy sleeves. They are probably one of the ugliest things I have ever worn on my body and I have definitely had some less-than-fashionable periods in my life. The nice thing about having to wear these and being not allowed to wear our own personal clothing while in the hospital is that it means I don’t ever have to dress up to walk to and from the hospital. After changing, we went to the simulation center and practiced intubations, peripheral IV placement, and spinals after a not-so-brief 30 minute coffee break. Just before lunch, the surgeon in charge of international medical students and our rotation as a whole popped in to introduce himself and greet each of us. He was very friendly and seemed genuinely happy to meet us which was confirmed later that day by an email he sent us stating just that. 

By the time lunch came, Åsa brought us all to the cafeteria and lunch was provided on the anesthesia account. It was a delicious array of food in the cafeteria and since my protein that I bought for myself consisted of some peanuts, cheese, and peanut butter, I decided to load my plate with fish and fresh vegetables. Coffee is a very important part of the Swedish life and we had our second coffee break of the day after having lunch. Over the past week, I have realized just how important these coffees are. Everyday I have taken at least two coffee breaks with my mentor. And a coffee break in Sweden is not grabbing a coffee and getting back to work or even taking a 15 minute break. No. Coffee breaks in Sweden last for an HOUR. You get your coffee, you sit down and chit-chat for an hour. Twice a day. At least. Our days are not that long to begin with, but I could be home by lunch if we just worked and didn’t take such long coffee breaks! But, I am embracing the culture of where I am living, so I will take my several hour long coffee breaks and just be glad that I get free coffee and don’t have to worry about dealing with a caffeine headache while I’m here. During lunch and coffee, we talked some about health care in our respective countries, about each of our medical education systems, and about a typical day as a medical student/resident/physician in each of our countries. In Sweden, a typical workday for most physicians and medical students is about 730 in the morning until about 4 in the afternoon except for Fridays when we are done at 2. Sometimes they will go until 5 or 6 (especially surgical fields) but they also include in there a legitimate hour-long lunch break and two hour-long coffee breaks. They are guaranteed 3 weeks of vacation per year and for every night or call shift they take, for one hour worked, they get 2 hours of vacation time which adds up quickly. So most people end up with a couple months of vacation time per year. If an anesthesiologist works night shifts, he/she will work 2 or 3 in one week and that’s it. No day shifts in between - just 2-3 shifts starting at 230 in the afternoon until 9 am the following morning. There is both maternity and paternity leave with each person getting 8 months paid off for having a baby. This time can be extended so if you only want to take 2 or 3 days per week off, you can have your maternity/paternity leave extended for longer. Also, if you have children under the age of 8, you have the right to work part-time with getting some sort of subsidy for you lack in income. Daycare is also subsidized by the government so it is extremely affordable for parents to return to work after their 8 months of baby-leave. 

Medical training in Sweden is also very different. Their public school/mandatory education goes until age 16 after which they do 2-3 years of “Gymnasium.” Gymnasium consists of either continuing general education (math, science, literature, etc.) or learning a trade. If you have continued general education, when you finish gymnasium and want to go onto further education, you choose either social sciences or hard sciences tracks - this also includes a medical school track. If a person chooses medical school, then starting at age 18/19 they have 5.5 years of medical school. When that is finished, they take 12-16 months to work as a sort of apprentice physician in a field of their choosing (which they are paid for). Then I think at that point they become “authorized” physicians. Either that or they become “authorized” after completing their internship. Internship is about 18 months long and includes internal medicine, psychiatry, general surgery, and general practice. After internship, they take an exam for licensing  and apply for residency in whatever field they choose. Residency is generally around 4 years in length and varying specialties have different difficulties in getting into. Interestingly, anesthesia also does intensive care. Internal medicine and pediatrics are all sub-specialties - you choose a cardiology, infectious diseases, etc. within those. General practitioners are the clinic doctors and take care of everyone. There is no such thing as a formal fellowship for sub-specialization within a field. 

There are also things I’ve noticed that are different in hospital practices. Antibiotic-resistant bacteria are uncommon in Sweden so they take extreme precautions when it comes to things like MRSA. Any person who has traveled outside of Sweden recently and comes to the hospital is presumed to have MRSA and is basically put into isolation with one-on-one nursing until MRSA status is confirmed to be negative. I had to be swabbed myself for MRSA - results are still pending. I’m not really sure what will happen if I am positive beyond getting re-tested. Hopefully it wont come to that! Also, we wear plastic aprons when taking care of patients that must be changed between each patient encounter to decrease the spread of germs. In the OR, unless you are fully scrubbed into the surgery, you don’t wear a mask except when you are in an orthopaedic or vascular surgery procedure. The reason for this is supposedly that a mask only keeps respiratory flora contained for about 5 minutes then it is as if you weren’t wearing a mask at all. However, the fact that you then have to wear them for ortho and vascular surgeries to decrease the potential for infection makes little sense. I think this may be one of those things that is just policy without necessarily much definitive reasoning behind it. Also in the OR, people are allowed to wear sandals - most people will wear them with socks but there are some that wear sandal with no socks. And there are no shoe covers either (I think there might be for joint replacements, but not for most surgeries). As I continue to see differences in practice, I will continue to write about them just because I think it’s very fascinating. Everyone seems to think that there is only one way to do things (usually the way that that particular person does it) and I simply don’t think that’s true. 

My first few days on anesthesia, I got to do an intubation and a spinal and help with masking and bagging. Then when we switched departments mid-week, I was with a Swiss anesthesiologist living in Sweden who didn’t let me do anything. So, by the end of the week, I was ready for the weekend and ready to be done with this part of the rotation. Next week I am on general and emergency surgery which will hopefully be interesting. Apparently Södersjukhuset has the largest and busiest ER in all of Scandinavia which hopefully means a busy week of surgery! 

One last thing I found interesting about last week. Smoking rates are similar in Sweden and the US (at least from what I heard from one of the physicians) but a thing called Swedish Snuff has started taking the place of smoking especially among the men in Sweden. So far, no definite link has been made between the use of this snuff and oral cancer. It’s sort of like chewing tobacco but apparently different in ways I don’t understand since I’ve never used either and don’t plan to. It’s highly addictive. I kept an eye out for it after I was told about it and noticed a few male physicians stuffing their lip with the snuff while at the hospital...it’s definitely as unattractive as watching someone chew (no offense to anyone who chews that is reading my blog - but it really is kind of disgusting). Well, I will keep you all posted 1-2x per week, more if something really exciting happens. Until next time, hej då!