A few years ago I saw myself as a bit of a defender of privacy. Now I’m slightly older (and wiser?). I wonder whether identity cards – traditionally opposed by “defenders of privacy” – are in fact the way forward to improvements in healthcare.
In January this year I started working in Sweden after medical training in the UK and several years working in the NHS. My husband’s job had necessitated a move to Sweden, and after much soul searching I had decided that I really wanted to carry on being a doctor and that that was going to be really difficult if I didn’t work for another three years. So I learnt Swedish and got a job.
No system is perfect, but a few things in Sweden have really opened my eyes. One is the prescription system, which is almost entirely electronic. I meet a patient or speak to them on the telephone, write their prescription on the computer using their identification number (“personnummer”), press a button that says “send to every pharmacy in Sweden”, and that’s it. No paper at all is involved in the prescription – it’s up to me whether I print out a medication list for the patient’s information or not. With regards to the actual prescription, they leave with nothing – no paper, no password, nothing.
The patient then goes into whichever pharmacy they choose, states their personnummer which individually identifies them, shows their photo ID card (which everyone has and which confirms their personnummer) and gets their prescription.
There is a system for getting temporary identification numbers for non-Swedes. There seem to be good controls in place for getting a personnummer and an ID card in the first place. In fact the existence of the “personnummer” seems to make everything about healthcare simpler. It´s all you need to uniquely identify a patient and consists of their date of birth plus four extra digits.
So whether I am looking at their notes (all electronic of course), ordering investigations (also electronic) or contacting social services or government authorities on the patient’s behalf, all I need is that 12 digit number. It´s so simple I can’t quite believe it, but it seems to work.
Occasionally I have commented to colleagues or friends that we don’t have ID cards in the UK because people worry about privacy and individual freedoms. They look quizzical and ask “How do you identify yourself?”
I start to explain that I take in a couple of old gas or electricity bills and maybe my passport or birth certificate……and never get much further because they’re laughing with incomprehension.
Alison Godbolt is a specialist trainee in rehabilitation medicine, Uppsala University Hospital, Sweden.