21.09.2023: Yet again proposals have been put forward to alter the set training rotation for the first stage of specialty training after medical school. It's a bad idea. Bærum Hospital, February 2016: It is just after 3.30am. I am about to clock off after a twelve-hour shift as duty doctor on the medical ward. Earlier that night, I had already dealt with four incoming patients with chest pains, and two patients with COPD flare-ups. Yet another patient now presents with shortness of breath. Båtsfjord, a few weeks later: I am the only medical practitioner on duty in the area. The senior doctor on call has...

28.08.2023: When those on the executive floor have a perception of reality that is at odds with reality as perceived by healthcare professionals in hospitals and GP surgeries, there is a risk of undermining the very trust that keeps the health service working. This year, like most years, the Arendal Week offered a wide range of health-related events and sessions. I was particularly keen to attend the meeting hosted by Central Norway Regional Health Authority to discuss their introduction of the Helseplattformen medical record system (1). General practitioners and hospital staff despair over the many...

14.08.2023: Everyone needs to take part in the discourse about our well-being in the workplace. 'What do I do if my pager goes off when I'm on the toilet?' She hadn't said anything up to this point, sitting tucked away in the corner, but now she was asking the question on all of our lips. It was the early 1990s and we were 12 house officers on our first day of work at a medium-sized hospital in Central Norway. We were excited and a little scared – at least I was. I do not recall the answer we were given. But I hope no one advised us to avoid the problem by not drinking. Because among all the stories this...

21.06.2023: If we want to change the population's eating habits, we need to understand why we eat the way we do. In March 2023, the revised Nordic Nutrition Recommendations were released for public consultation (1). The recommendations are based on knowledge summaries of several thousand scientific studies. Almost 400 external international researchers have been involved in the work at various stages (1). Nevertheless, as soon as the draft for consultation was released, the discord began. Some argued vociferously that the recommendations did not go far enough in warning against ultra-processed food...

12.06.2023: When information on your health is collected, you should have equal protection under the law whether you are a source in a newspaper report or a patient in a research project. During the last cross-country skiing season, the Dagbladet newspaper published a series of articles on eating disorders among Norwegian athletes (1). Under the collective title 'A sick skiing nation', the findings caused a stir and led to 'public apologies, changes in coach training and investigative initiatives' (2). It is commendable that the press has provided broad coverage where other social actors (namely, sports...

08.05.2023: The global community has been trying to overcome the obesity epidemic for several decades, all while people have only been getting heavier. Have we finally found the right medicine? Elon Musk has done it. Hollywood stars do it. A small jab in the skin once a week. That's all it takes to lose weight – at least if Twitter and Instagram are to be believed. The wonder drug has become so popular that diabetes patients who need this medication cannot get hold of it. GLP-1 receptor agonists (glucagon-like peptide-1 receptor agonists) stimulate insulin secretion and inhibit the production of glucagon...

25.04.2023: I asked ChatGPT to write an editorial about the use of ChatGPT in research. It enthused about itself, but I am more sceptical. The technology is immature, and its use needs to be discussed and regulated. New, large language models such as ChatGPT are based on deep learning and the gathering of information from vast volumes of freely accessible digital texts. Based on this, they produce synthetic text in response to open-ended questions. The result is almost indistinguishable from human-created text. What implications will such technology have for research? In order to get good answers to...

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...