Danish Health Care Adventures.

So, I think my family and colleagues already know about events this weekend, so I’ll post a bit of a summary.  If you didn’t know, then you can find out below, although the purpose of this blog is really to give a summary of my interaction with the Danish Health Care System so far, for those who may be considering moving here.  Thus, I’m writing it to cover our interactions over the past two months – not just this weekend.  But you can skip on below, if you’re just interested in that part of the tale.

First, for those who don’t know, my wife and I are expecting a child in May – and so we’ve already had a few opportunities to learn how health care works here.  It’s not better or worse than what we’ve left behind in Canada – it’s just different.  Americans will probably freak out when they hear about it, but for Canadians, there are a lot of similarities and a lot of very subtle differences.

My wife has had the pleasure of meeting health care professionals already in several capacities, and her appointment with the ultrasound clinic stands out vividly for me.  The first ultrasound at about 8 weeks was done in Vancouver, done in a private health clinic.  The Canadian health care system paid for the visit, but the clinic was still private – and was plastered with adds for having a 3D ultrasound done in order to get a better picture of your child.  The appointments were fast, the technician highly competent and the results were given quickly.  If you ignored the brochures, you wouldn’t have known you were in a private clinic.

In contrast, the 20th week ultrasound was done in Denmark, at a hospital near our house.  Oddly enough, we were given two separate appointments – one on a Friday, and one the following Monday.  Unable to determine why we we had two appointments, but repeatedly told both were necessary, we simply went to the hospital when we were told to be there.

We walked over (as we walk just about everywhere), and got lost in the sprawling but nearly empty hospital.  Once we found our way to the ultra sound clinic, we swiped a card to notify them that we were there and then sat in the waiting room till the appointed time, when the technician showed up in the doorway and called my wife’s name.  They asked if we spoke Danish (we didn’t) and then were relieved to discover that we spoke English.  (The alternatives would have been difficult, I’m sure.  My French is highly rusty, and I doubt they know any Mandarin.)

Once in the room, we were told that a pre-natal heart specialist would join us, if he could – and, slightly more than halfway into the hour, he joined us and worked with the technologist to do a very throughout investigation to rule out any possible heart defects.  Apparently, having taken my wife’s history, they had flagged the need for a specialist and made the second appointment for the following week – but then had discovered that the heart specialist would be available at the time of the first appointment and amalgamated the two appointments.

In Canada, it’s unlikely that the specialist would have been involved, or that all of the components of the health care system would have been synchronized appropriately to blend, reschedule and coordinate specialists and technicians for our convenience.

To say the very least, we were very impressed with the efficiency of the Danish health care system in this respect.  (And, also to have been reassured that the baby is looking healthy from all angles!) Appointments continue to be scheduled for my wife with great efficiency via letters that frequently appear in the post.  Alas, they’re all in Danish, but we’re becoming more adept at reading them with the help of google translate. (Google translate employees, if you’re reading, we owe you big time, not the least of which for helping us learn Danish quickly!)

With that in mind, the events this weekend were a challenge to the health care system from a completely different direction.

Last Tuesday, I started to get sick – my voice dropped down into the range of David Attenborough’s, and the tissues/kleenex began to sprout in big piles.  Unfortunately, I started a business trip on Wednesday last week to Holland.  I won’t cover that in any detail except to say that by Friday, I was coughing quite a bit.  Fortunately, I didn’t have to say much during the meetings, but I’m sure I seemed unusually quiet and reserved.  (or sniffly, depending on the meeting.)

By Friday evening, I was at home and my cough worsened – probably due to the flying and cold air on the way home.  By Saturday, my cold had gotten a lot worse, and with the rainy weather, my wife and I canceled our plans for walking around downtown.  Saturday evening, the pain set it.

I’m no stranger to chest pain – I’m a tall and thin male, prone to spontaneous pneumothoraxes.  That’s when little weak spots develop on the lung, which can spontaneously burst, letting air fill the space between the lung and the chest wall.  Normally, that space is empty, which causes the lung to inflate as the chest wall swells, and to deflate as it contracts again. Hence, inhaling and exhaling as your chest moves.  With air in that space, the lungs are constricted, and it can be hard to breath in and out.  Normal causes in people who aren’t tall, thin males include gunshot wounds, being stabbed with a knife and broken ribs puncturing the chest wall.

Fortunately, I haven’t had any of the latter, but with a history of collapsed lungs, I have had a staple installed to hold up  my right lung so that it doesn’t collapse on me.  I don’t notice it anymore, and if my lung does anything stupid, it usually fixes itself quickly.  When a sharp pain started in my chest – in response to a LOT of coughing – I just assumed that’s what it was.  Another collapsed lung that would just pass in a bit.  Unfortunately, it didn’t.

It hurt to lie down, but like a collapsed lung, hurt when breathing in and out and changing positions was like having a knife shoved into my back.  It hurt a lot – but nothing I couldn’t handle, I though.

Sunday morning was a disaster, though.

I sat up slowly from bed and the pain was immense.  My wife asked if we should go to the hospital, and I said no, I’d be fine if she give me a minute.

Then I started to feel faint – and I changed my mind.  We should go to the hospital, I said… and then I blacked out.

Coming out of the blackout was strange.  I couldn’t feel anything – I couldn’t tell if I was breathing (I thought I wasn’t)… and it took a while before I could open my eyes… and even longer before I could hear again, and then another few seconds before I could control my limbs.  Apparently, I was thrashing around for a while, while trying to regain feeling.  I must have looked like I was a goner.

The scary part was that she didn’t yet know the emergency phone number (112 in Denmark) and couldn’t reach any of our friends.  She had to wait helplessly for me to regain consciousness before I could remember the emergency number from the welcome to Denmark package we were given. (Thank goodness for that package!) and was able to contact a nurse.  Here, you’ll see the differences between the Canadian and Danish systems.

First they asked if I was still awake and to see if I was likely to fall unconscious again, and when they determined I wasn’t about to die, we were asked if we could get to the hospital ourselves (No, we don’t have a car), then told that a doctor would be sent within the next 2 hours.  In about 10 minutes, the doctor arrived.  She quickly checked to see what the problem was and to ensure I’d live.  Once my life was clearly determined not to be in danger, she placed a call for an ambulance to pick me up.  Again, we were told the ambulance would be there in the next two hours. The only question I was asked that wasn’t directly medical was when they asked for my CPR number (Danish identification number) on the phone – equally likely to find my medical history as for billing, however.

15 minutes later, an ambulance crew arrived at the door with a gurney.

I was able to walk to the ambulance and felt comfortable sitting in one of the jump seats in the back.  The guy in the back with me kept me talking (in English) all the way, clearly making sure I didn’t fall unconscious again, and even gave me oxygen.  Unfortunately, the guy in the front of the Ambulance, where my wife was riding, didn’t speak English, so the front was a lot quieter than the back.  I have to say, though, that the driver was fantastic – I could feel every bump with a sharp chest pain – and it was one of the smoothest car rides I’ve ever taken.

Within a few minutes, we arrived at the hospital downtown from which we were redirected to another hospital downtown.  (All this, despite the fact we live a 3 minute ride from yet another hospital.) In any case, after a second ambulance ride, we arrived at the correct destination, where we said thanks to the ambulance crew and were ushered into a room with two beds.  For most of the day, the second bed stayed empty, giving us an almost private room. (When it was occupied, it was by a smoker, who kept going outside for nicotine fixes… which didn’t really help, but nothing I could do about that.)

With a few minutes, I was taken for a chest X-ray, and shortly after that, the nurse came to see us and let us know (in rather halting, but understandable English) that the doctor would check out the x-ray and blood would be taken shortly.  At this point, I was feeling better, but in a lot of pain – that is, I was clearly in stable condition and in good hands.

The biggest visual difference between the Danish heath care system and the Canadian health care system is the uniforms.  At the risk of offending people, lets just say that the doctors uniforms are vaguely reminiscent of an outfit that would fit well in a Village People’s video.  Tight fitting shirts and pants in white, with a fitted lab coat.  It is the anti-thesis of scrubs.  In contrast, the hospital itself was quite spacious, plenty of room and well maintained.  It didn’t have the same underfunded/understaffed feel of typical urban Canadian hospitals.

In any case, we had a great doctor who spoke quite decent English. He explained that the condition was not my lung at all (a giant shock to me.) and that it was probably an inflammation of the membrane around the heart.  The symptoms all fit, and the chest x-ray showed absolutely nothing going on in the lungs at all, as confirmed by a radiologist.  At this point, I must have dropped way down the priority list, as long waiting periods crept in.

We were offered some food (meats and sauces on open faced sandwiches – a typical Danish meal), and then a colleague from work came by to check on us.  She cheered us up, helped ask some questions for us and made the day go by much more quickly.  Later on, she even helped by walking our dog!  Apparently, she also told everyone we knew as well – which wasn’t a problem, but a surprise.  It led to a lot of offers of help from a lot of people, some of whom I barely know.  A fantastic show of support from my Danish (and non-Danish) colleagues for which I’m very thankful!  (I won’t drag any of them into the blog, though, without their permission.)

Although the time between contacts then slowed down, throughout the afternoon, I was given an EKG, which found some slight disturbances in the force…  (electromagenitic force, that is.)  My heart then became the key suspect.

Further blood tests would be done on the blood taken earlier in the day and an ultrasound of my heart was scheduled, which brought in a second doctor, who’s name was Tor.  (He said it like Thor, tho…  and who hasn’t wanted to be treated by a doctor named Thor?  Seriously, I doubt there’s a single doctor in the entire Canadian system named after a Norse god.)

The ultrasound was unfortunately inconclusive and we were told we’d have to wait about an hour for the blood test.  One hour turned into two, and the blood work itself was inconclusive as well.  However, the doctor was relatively certain of the diagnosis of paracaditis, for which the treatment is anti-inflamatory medication and painkillers:  aka, ibuprofin. I was let go with a day’s worth of medication, orders to fill a prescription at the pharmacy and with a strong suggestion that I get some rest.

So, here I am, two days later, feeling a lot better, but still on some mandatory down time.  The cough is going away, helped by some over the counter throat lozenges, and the pain is masked and relieved by ibuprofin.

The only interesting addenda to this adventure is that I was told that anything a doctor prescribes in this country is free – anything you chose to do on your own is self-paid. That’s not quite true – I don’t know the full cost of the pills I was prescribed, but I did pay about $6 (31 dkk) for them.  If that was a dispensing fee, it wasn’t explained to me.

Finally, the drug stores here are also interesting: the doctor won’t give you a prescription to take there – instead it’s entered into the computer system, which the pharmacist can then verify when you provide your CPR number.

Slightly stranger, the pharmacy to which I went wasn’t actually a pharmacy – it’s an outpost of a pharmacy.  When you go in, they place the order at the other store, and have someone bring it over a couple of times a day.  So, the first trip over is just to tell them you’ll be using them to get the drugs and the second visit is to pick up the drugs and pay for them.

As it happens, the woman at the pharmacy was very interested in learning English and Spanish and made me practice my danish pronunciation when picking up the pills – as well as advice that I should learn spanish and go on vacation there… (-:

That said, it’s been a couple of hectic days.  I’ve come to respect the Danish health care system and it’s staff – and I’m glad I took the time to ask a lot of questions over the past week.  Without some of the basic information, the whole process would have been a lot more scary than it was.  And, word to the wise, learn the emergency code in every country you travel! You never know when you might need it.

Finally, in case anyone is worried, I really am doing better, and I don’t think anything in this whole misadventure was life threatening.  The treatment was swift and efficient and I’m sure I’ll be back at work shortly.  I have lots to do, and I’m very eager to get back to it.

 

6 thoughts on “Danish Health Care Adventures.

  1. Hi Anthony,

    I’m an occasional lurker to your blog. I came across it through the regular NGS sequencing channels. I am working on sequencing cancer cell lines for mutations in Vienna, Austria. You and I have a lot of parallels. I came to Vienna from the US in 2007. Seeing your posts about adjusting to a new country reminded me of my transition. My wife is also pregnant with twins and due in May. I have also met people from CLC (they regularly visit Vienna to show us their software). If you ever come to Vienna let me know. I would be happy to meet you and show you around!

  2. Thanks German,

    It does sound like we have a lot in common. I’m guessing that you also probably won’t be doing a lot of travelling in the near future, but if you’re ever up north, feel free to let me know. I’ll reciprocate the same offer!

    Congrats and good luck to you and your wife!
    Anthony

  3. Came across this blog by chance when searching for info on DNA sequencing in DK. Being an MD in Copenhagen, I’m very pleased to see that you were treated well, both by the individual nurses and doctors, and by the system as a whole! Often the stories that reach the media and blogosphere are the unfortunate ones where something went wrong. So, nice to see that things can work smoothly, from a patients’ perspective. Best regards!

    • Yeah, sorry I haven’t written much on DNA sequencing in DK – I’ll get to that topic at some point, although my usual topics are far more bioinformatics related than sequencing itself. In any case, I agree that much of what makes it out into the blogosphere is negative, simply because the negatives are what inspire people to become emotional enough to write out their perspective. Anyhow, I’m glad you enjoyed the post! Cheeers!

  4. Btw: I laughed out loud at the “village people” analogy! It was actually worse a few years ago when we had tight-fitting white semi-see-through t-shirts (“net-undertrøje” in Danish – don’t know the English word).

    • “net-undertrøje” comes up in google translate as a net undershirt. I’m picturing this as a fishnet-stocking t-shirt… but that just can’t be right! That’s well beyond village people and well into the Madonna territory.

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