The Star Chamber

...On January 6th 2005 an insane man stabbed his old, 84 y/o mother at Otta (look it up in the map, it lies in the long valley called Gudbrandsdalen north of Lillehammer).

The police and the local doctor came to the crime scene; the doctor stabilized the old woman and called for the ambulance. When he had done what he could do for her, he left the scene. The ambulance came and drove her to the nearest hospital (Lillehammer). The woman later died of her injuries.

A sad story? It gets sadder still: The police reported the doctor to the Board of Health (which is by itself rather disgusting behavior, the least they could have done were to indict him before a regular court where he at least would have a fighting chance). The police felt that he should have ordered a helicopter instead of an ambulance, and that he should have stayed at the scene until the ambulance arrived.

Now the Board of Health have finished their inquisition "inquiry", but much to their chagrin they weren't able to find any faults with the doctor's behavior.

So is this a sunshine story? No. The inquiry is now on his record forever, and the way the Norwegian Board of Health functions, no-one is completely innocent aymore once an inquiry has been opened. This doctor - although admittedly completely innocent of any wrong-doing, dereliction of duty, malpractice or negligence, is now one step closer to losing his licence.

The genius of it all is that he has no opportunity whatsoever of protesting or appealing as he hasn't been reprimanded (although he has, hasn't he?)

Franz Kafka would have recognized it...after all, he was a lawyer too...

Now the court has spoken:

Little Jonas, 5 y/o, is entitled to compensation for his plexus palsy after shoulder dystocia at birth.

This is rather unusual, but the court's reasoning is even more bizarre:

- When the written records of the operation [the delivery], which is the best source of information as to what happened and what was done, is incomprehensible, we see this as evidence that the treatment has not been adequate...

...it is irrelevant whether it is the foreign doctor's poor knowledge of Norwegian that is the cause of the incomprehensible records. The court feels that it is not subject to discussion whose responsibility it is that the written records are incomprehensible.

Another victory of the Law over evidence-based medicine. And the court may kiss my behind; both cheeks, both lips, anytime. The same offer goes to the medical prostitute who was "expert witness" in this case, and whose job it was to explain the records to the officers of the court; a job in which he failed miserably - but in the process he threw another practitioner under the bus.

Set me up one more.

is the deficit Norwegian public hospitals are running this year.

Norwegian Hospitals are not "making money" as they do in the US, they are being reimbursed by the government for every patient they treat, but after a ridiculous Soviet-style system called DRG (Diagnosis Related Groups), and the sheer ridiculousness of the system has called forth some quite ingenious creativity:

- Almost immideately the bean counters calculated what diseased were most "profitable" (gave the highest DRG-reimbursement) and focused on these, no matter what.

- Complications give a higher reimbursement. If you guide a woman through a normal, vaginal childbirth, the reimbursement is very little; if you do a cesarean without any medical reason at all you are making money, if you manage to infect her with streptococchi you can actually make a bundle, and if she ends up in ICU with a tracheostomy you're in the clover. So the drive to reduce unnecessary cesareans always flounders. I even had the chief of finance on the hospital call me and ask why we didn't do more cesareans.

- Some hospitals found that it paid off to hire a doctor exclusively to construct and look for the most profitable DRG-codes for each patient - it paid off to have a doctor who never saw a patient. Unfortunately, some of them took their job so seriously that they actually invented procedures that never took place.

- Treatment of a disease with operation is heavily reimbursed, treatment with pills less so. If a woman complains of heavy periods and you take her entire genitalia out - major surgery - you get quite a lot of money from the Government. If you treat the same condition with hormones, you've lost.

- When this effort was taking place, the government struck back; the reimbursement rates were lowered if the production went up. So that now the reimbursement for almost every disease imaginable lies under the actual cost of treating the disease.

So what now? Only two possible ways to close the deficit: Treat fewer patient or make the government shell out more money. The last option is cleary out

The first one is actually out too. Every time the Hospital management some place or other tries to cut down on the service, the Minister of Health steps in and stops them.

So the deficit will keep on growing - and growing - and growing.

A female drug addict was on an institution for rehab. This insitution had a number of rules, an one of them were that drug abuse within the institutiion was ground for immideate dismissal.

The woman was caught with positive urinanalysis, both staff and other patients had seen her taking drugs, and she was dismissed.

So she complained to the Board of Health, who ordered the institution to take her back; on the grounds that there would be "a danger of relapse" if she was out of the instituton.

Hallo? Relapse? She had a positive urinanalysis - she has already relapsed! Surprise!

What the Board of Health actually has said now, is that all other patients that are being treated for drug addiction are free to shoot up during the treatment. This reduced the rehab institutions to something akin to hotels.

How long are we going to keep these idiots?

A young man went to see doctor # 1 about shoulder pains in september. The doctor was his regular GP, he examined the shoulder, and made a diagnosis of tendovaginitis. The treatment was accordingly NSAIDS and rest.

Two weeks later the man went to see doc # 2, as the shoulder wasn't any better. Doc # 2 ordered an X-ray of the arm and shoulder; the patient however never showed up for the x-ray.

Six weeks after that, the man saw doctor # 3 about the shoulder. The diagnosis of tendovaginitis was made for the second time.

Two weeks after this the final diagnosis was made, he had osteogenic sarcoma and the arm was amputated at the shoulder joint.

The Board of Health has published some more than usually nonsensical rubbish in this case. Two of the three doctors are criticized (probably # 1 and # 3, but you never know), although the B of H has a hard time telling us exactly what they have done wrong:

The treatment they have given the boy has not been according to good practice

- which is more or less saying that "we can't say what they have done wrong, but we're giving them a scolding anyhow".

As far as I can see, only one person has done something wrong here, and that person is the patient. Doctor shopping combined with non-compliance is the patient's own responsibility, and in my book that's it, and that's that.

There is no way a doctor can protest against or appeal this kind of criticism, unless he runs an anonymous blog (heh, heh). But I hope the Board of Health in some way is made to realize how much they are despised by the medical population.