28.03.2023: Hoping is more than believing that all will eventually be well. In the Christian tradition, Easter is the season of hope. In this issue of the Journal of the Norwegian Medical Association, Odd Terje Brustugun explains how hope still has a role in doctors' encounters with seriously ill patients (1), while Aslak Bråtveit shares his thoughts on how we can find hope both inside and outside the confines of the church (2). But what is hope, really? Psychology distinguishes between two dimensions of hope (3). The first one consists of three parts: a desire to achieve something, a plan for how to...

13.03.2023: Our public health service is struggling. The employees must be treated as the scarce commodity they are. A growing number of doctors and other healthcare personnel are leaving the public health service. The high pressure of work they have to deal with is nothing new. However, the warning signs that are coming thick and fast from many different parts of the sector indicate a change of pace (1–3). The health service is being stretched to its limit. The underlying question is: Who is going to stay in the health service for the long haul? Because things are going to get worse. In February, the...

20.02.2023: Hard-pressed hospital finances will be further squeezed in 2023. But there are those who will profit from it. In her speech to the hospital sector on 17 January 2023, Ingvild Kjerkol, the Minister of Health and Care Services, announced austerity measures, reduced wiggle room for hospitals and cuts in public spending (1). This did not exactly come out of the blue. Before Christmas, it was clear that the fiscal budget for 2023 represented a de facto reduction in the already hard-pressed hospital finances, because estimated inflation in the 2023 budget was 2.8 % (2) while Statistics Norway's...

30.01.2023: Specialty registrars are responsible for their own learning in an unpredictable specialist training programme in which the day-to-day work may take precedence over learning activities. The lack of clear regulations on specialisation can result in a delicate balancing act. New regulations on specialty training for doctors implemented in 2019 state that hospital doctors without a speciality must be employed as specialty registrars (1). One of the goals is for doctors to complete specialist training. It would be easier to accomplish this through regulations that more clearly define the balance...

16.01.2023: Despite the low temperatures in Norway, we are not used to being cold. But the persistently high electricity prices may also trigger the fuel poverty phenomenon here too. In Hans Christian Andersen's fairy tale 'The Little Match Girl', New Year's Eve is being celebrated in the fine homes of Copenhagen. Outside stands a little girl with no shoes or hat, selling matches that no one buys. She is poor, cold and freezing to death. In Norway today, 175 years after the 900-word tale was first published, it seems banal and irrelevant. However, in the cold month of December that has just passed, the...

12.12.2022: When there is no room at the inn, women in labour lose the battle for beds – just like 2,000 years ago. 'And so it was, that, while they were there, the days were accomplished that she should be delivered. And she brought forth her firstborn son, and wrapped him in swaddling clothes, and laid him in a manger; because there was no room for them in the inn.' (1) The story of Jesus' birth is fascinating for many reasons. However, the very idea that the manger served as a childbed for Mary has always struck me as illogical: when a woman in labour has travelled from afar and is unable to find 'room...

21.11.2022: Are you reluctant to open the Journal of the Norwegian Medical Association? You don't have to be. Medical students must cope with textbooks and websites, lectures and PowerPoint presentations. So will they have time to read a scientific medical journal, and will they benefit from it? We regularly discuss this question on the editorial board of the Journal of the Norwegian Medical Association. In 1998, Steinar Westin and Per Brodal, both of whom are experienced teachers and long-standing members of the Journal's editorial committee, had a meeting with a group of medical students (1). Many of...

07.11.2022: Who are we? Where do we come from? Such questions have intrigued people since time immemorial. Only the tools used to dig through the past have changed. For days, Reykjavík has been shrouded in dense fog. However, as we step out of the headquarters of DeCODE genetics, the clouds are breaking up. A rainbow arcs from the big grey building, across the city centre and all the way up to the Hallgrímskirkja church. It is said that at the end of the rainbow lies a pot of gold. In the basement, underneath all the laboratories, lie blood samples from more than half of the population of Iceland in a...

20.10.2022: Sometimes diagnosis and treatment choices are obvious. More often, curiosity, reasoning and good judgement are required. Diagnoses are made on the basis of the patient's reported symptoms and the doctor's findings in clinical examinations and supplementary investigations. Sometimes the diagnosis seems obvious: an experienced doctor will recognise a pattern that fits a certain disease. On other occasions – perhaps far more often – the diagnosis is not immediately apparent. In such cases, important symptoms and findings must be used as a basis for clinical reasoning and targeted tests that can...

12.10.2022: How can we reduce school drop-out rates, halve the gender gap in education, increase wages and make children smarter? Try deworming tablets. It goes without saying that treating illness is good for a person's health. But it can also be an effective way of helping them to escape from poverty. At least that's what a large study that provided mass deworming treatment to schoolchildren in rural Kenya appears to show (1–3). The children were treated for intestinal worms and schistosomiasis, both of which are on the World Health Organization's list of neglected tropical diseases. Such diseases...

26.09.2022: If the introduction to an article does not tell readers why you conducted the study, they are unlikely to read any further. Imagine you are taking a friend on a road trip. What is she thinking about once she has settled into her seat? Probably something like this: Where are we going, and why? At least that's what the author of the article 'Introduction sections: where are we going and why should I care' (1) thinks. I like the analogy: When you write, think of the reader as a curious colleague who is not familiar with your travel habits or where you like to go, but who is listening intently to...

05.09.2022: Effectiveness research should be given more space in public policy. But not at all costs. The previous government extended the opening hours of the Norwegian state-owned alcohol monopoly's sales outlets. However, alcohol consumption did not increase (1). This means that extended opening hours do not lead to increased consumption, one politician recently claimed on the evening news (1). This argument is obviously fallacious; the co-variation could be due to anything that might have happened in the meanwhile. We may soon have a better answer. While planning for the extended opening hours, the...

16.08.2022: Norway only trains a bit more than half of its own doctors. In a global perspective, this is a shameful statistic. Almost half of all doctors working in Norway (45.2 %) undertook their medical training abroad (1). In terms of how many doctors each country trains per inhabitant, Norway is ranked 26 out of 29 OECD countries (2). Even at the bottom of the list, Norway stands out with its particularly low proportion of doctors with a foreign background trained abroad. In the spring of 2021, 87 % of foreign-trained applicants seeking junior doctor positions in Norway were Norwegian (3). The number...

27.06.2022: The WHO report on art and health was overshadowed by the pandemic. Time has now come to convert the report into prescriptions. Towards the end of the play 'Tid for glede' (Eng.: 'Time for joy'), currently playing to full houses at Det Norske Teatret, there is a moment of deliverance: the actors shed off their heavy rococo costumes, pour buckets of water on the floor and slide jubilantly and at high speed across the slippery stage. Thereafter, all borders are dissolved. The party gathers in a heap of bodies that discuss the prerequisites for joy, their gazes subtly addressing us in the...

14.06.2022: The global food crisis has gained pace due to war, the pandemic, and climate change. The vulnerability of the global food systems puts global health progress at risk. The massive increase in food production that we have witnessed over the last decade is one of humanity's greatest technological and scientific achievements. Thanks to the development of higher-yield crops, effective pesticides, artificial fertilisers and advanced agricultural engineering, we produce more than enough calories to cover the needs of humanity – despite the fact that there have never been as many people on Earth as...

02.05.2022: Case histories are not research projects. It is therefore difficult to define who should write them. Case reports form the core of medical science and medical disciplines. The stories of the patients we learn from constitute the human factor in diagnoses – including in the medical literature. These reports have several functions, the most important of which is to describe the unknown, unexpected or unusual: a new disease, possible reactions or adverse effects of a treatment or intervention, or possible unknown manifestations of a disease (1). In all cases, the intention is for the reader to...

04.04.2022: Medical assistance for a large group of people living in Norway is arbitrarily and poorly organised. Soon, the problems will be even bigger. Some time ago, a sick man came to a doctor's surgery in Bergen. The examination that followed showed that he had cancer. He was referred first to one hospital, then to another. The referral was rejected by both hospitals. His appeal against the rejection led nowhere. Gradually, the man's condition worsened. This man had no papers that were recognised by Norwegian authorities. He had lived for years in Bergen, where he had received regular medical...

22.03.2022: Where is the demarcation between institutional responsibility and individual responsibility for mistakes made in the health service? An A&E doctor in the county of Trøndelag has violated the legal requirements for professional standards and compassionate care. This is the conclusion of Trøndelag's County Governor in a case where a young man died, probably as the result of a heart attack (1). The doctor had not examined the patient himself, but had spoken on the phone with ambulance personnel who were in the patient's home. The decision was made not to take the patient to A&E. The case...

25.02.2022: This year marks the 50th anniversary of the decriminalisation of homosexuality in Norway. Can we learn from the past and address our own prejudices and culture? 'Everyone took it well!' My brother had just come out of the closet. He was clearly relieved and happy. I shared his joy at first, but then I felt dispirited. As a heterosexual cisgender woman, I have never had to do something like this, where friends, family and strangers would comment on my sexual orientation. I follow the norm and consequently escape all of this. I fail to notice that the boxes of sexuality exist, that they are...

14.02.2022: Healthy teeth and gums give us a nice smile, but not everyone can afford them. Despite increasing prosperity in Norway over the last century, significant social health inequalities still remain (1). High earners with a lengthy education live longer and enjoy better health than those with less education and lower incomes. Dental health is a strong indicator of the disparities. Everyone who has experienced toothache has had an unpleasant reminder of the impact of our teeth and mouths on our mental and physical well-being. Good oral health is essential for core human activities such as eating...

24.01.2022: The 'blue prescription' scheme helps even out inequalities in health. Sanctions against doctors for erroneously issued blue prescriptions sit badly with our ideas of solidarity and health for all. As a general practitioner in a small village in Vermont, USA, I always needed to take the patient's financial circumstances into account in my choice of examination and treatment. Was the patient's COPD treatment-refractory? Or could he not afford to buy the drugs prescribed? Vermont is one of the more social-democratic states in the USA. I was nevertheless constantly reminded of the fact that I...

12.01.2022: Over a short time, science has produced effective vaccines against COVID-19, but has yet to fully answer the question of how we can persuade as many as possible to be vaccinated. One morning in 1962, Roald Dahl sat at his daughter Olivia's bedside. She was recuperating after a bout of measles. 'How do you feel?' he asked. 'I'm tired', she answered. The next morning she was dead (1). Twenty-four years later, the by then world-famous children's author wrote a letter to his local health authorities, asking parents to use the vaccine that had meanwhile become available (1). Dahl appeals to their...

08.11.2021: The medical degree programme places too little emphasis on strengthening the students' ability to express themselves. Language is closely associated with thinking and cognitive processes. We need words to understand and communicate our perception of reality. Doctors in all specialties use speech and writing to communicate with each other, with their patients and with society. Doctors' ability to understand and make themselves understood is therefore as important as knowledge and practical skills. Communication and language are core to the work of all doctors, including clinicians. Clear...

19.10.2021: The Hurdal platform paves the way for strengthening the public health service. However, the promises are numerous and somewhat vague. How well will they stand the test in the daily political grind and when confronted with the parliamentary majority? On 13 October 2021, the Labour Party and the Centre Party presented their government platform, which will form the basis for their policies in key areas for the next four years (1). The Støre government is keen to demonstrate its concern for 'ordinary people'. And ordinary people are concerned with health. It is therefore no surprise that health...

27.09.2021: If you wish to reach out to readers beyond your own professional community, you should use abbreviations sparingly. Many medical terms are long, and when they are frequently repeated in a text, the author might be tempted to use abbreviations, often in the form of acronyms. In many cases, such abbreviations will ease the flow of the text and improve its readability. Often, however, they will instead obstruct the flow, hinder understanding of the content and prevent the message from being conveyed. Abbreviations reinforce the identity and group cohesiveness of those who know what the...

06.09.2021: The traditional health policy issues have failed to turn up the heat in this year's election campaign. The greatest threat to public health comes from elsewhere. 'Health and safety first'. Such was the motto that the 2020 Annual Representative Meeting of the Norwegian Medical Association adopted as its foremost priority in the run-up to the general election in 2021 (1); and for a long time it appeared as though health would be the most prominent issue in the election campaign. The COVID-19 pandemic demonstrated how important it is to have a well-functioning public healthcare system. Small and...