Pressed skin clinic at Sös goes to the grave

The room is decorated with balloons, incisions and bubbles presented in the foyer of Södersjukhuset’s auditorium, which is filled with work-dressed nurses and doctors. Two hospital directors, Mikael Runsiö and Björn Zoëga, grab a large pair of scissors and cut ribbons to mark a fresh start.

Business area manager Anna Gerber Ekblom expresses mixed feelings.

– It is fantastic fun that we have found a way to continue to take care of patients. But for me who represents Sös, it is also a bit sad. The skin clinic has been at Sös for many, many years, she says.

In April, the health and medical care committee decided that Södersjukhuset’s assignment in skin health care, which includes skin and venereal diseases, would be terminated. The skin clinic, which has existed since 1944, is being closed down and becomes part of Karolinska’s operations. Cause: many layoffs of specialists and difficulty in recruiting new ones.

Now a rescue operation is taking place to maintain specialist care and manage the doctors’ education, as the training with the right patient mix takes place in healthcare.

Maria Bradley, responsible for medical students’ education in the specialty at Karolinska Institutet, describes major difficulties for skin care at Södersjukhuset and other hospital clinics as doctors disappear to private care choices, but points to new possibilities:

– NKS with its highly specialized mission and thematic division is challenging for the education, and Sö’s focus on common diseases and ordinary skin patients is well suited as an arena for education, she says.

Parts of the skin operation are judged to be able to be conducted in care choice, a form of privatization which in specialist care means that simpler procedures move from the emergency hospitals to private clinics, while the more complex care remains. The Stockholm region stands out with 38 care choices in specialist care.

Care choice skin belongs to care choices with high cost increases, 164 percent since 2012, and currently there are 20 private skin clinics with regional agreements.

Anders Ahlsson, Director of Health and Medical Care, states in an email response that the move will take place under good cooperation between the hospitals. He sees good conditions for training ST doctors, after a revision of the choice of care.

In the mingling outside the auditorium are the district nurses Eva Morgan and Linda Edman. They work in the skin clinic’s treatment center, for seriously ill patients with leg ulcers, psoriasis, and eczema, and who also support primary care. The future is uncertain.

– Our business is the golden egg for skin patients. If a patient comes in with enormous itching, we can offer calibad (treatment of severely itchy skin diseases, please note) and lubrication and prioritize that patient, says Linda Edman, who says that she is critical of the approach with the care choices that take the light patients.

Other people describe poor working conditions at Sös, as the specialist doctors have not been heard in an increasingly pressured work environment with seriously ill patients and little opportunity for research and further education.

– The problem has been to get specialists to stay, and it is not the choice of care that is the cause. SÖS has not done anything to change the situation. The focus has been on production, ie maximizing the number of patient visits, says a doctor who now works in care choice with better pay and conditions, but also lighter patients.

– Most of us want variety and more challenging cases. At the same time, I have a more flexible schedule and a greater opportunity to get through requests for leave.

Lina Ivert, chief physician at Karolinska, says that Södersjukhuset has had a specialized care that has been very important for patients with severe skin diseases.

– Some experienced specialists and chief physicians stay at Sös where NKS will try to support based on already limited resources, she says and adds that the skin operations at Karolinska are severely reduced.

Skin health care was recently forced to move from NKS and reduce the number of care places.

– If fewer seriously ill people can be taken care of at Sös, the skin clinic at Karolinska would probably get more resources, treatment rooms and expanded places at Stockholm’s only inpatient ward, says Lina Ivert.

The transfer does not involve any new resources.

Responsible politicians in the Stockholm Region have previously admitted that the choice of care was introduced without the task of training care staff being included in the planning, and only in recent years have demands been made on the private care providers. This is the second time that special solutions have been used. In 2019, Karolinska started an outpatient clinic for ear-nose-throat at Danderyd Hospital, so that medical students can see patients with common ailments.

According to Björn Zoëga, he was surprised this time by a phone call from the health and medical care administration early in the evening on 29 December.

– There were urgent problems, and I had to answer within a few days, says Björn Zoëga.

Is there a reason to celebrate?

– We celebrate the collaboration that has led here.

On the impact of care choice on skin specialty, he says:

– Many doctors want to work in the choice of care or in the academic world. Now we may be approaching university health care to address several of the common public diseases, a development seen in Europe.

Zoëga can not answer whether rescue operations for other specialties are to be expected.

– In the future, we may have to think about how self-care in the Stockholm Region should be organized.

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