‘We need an individual plan and approach for each patient, regardless of whether it’s a woman or a man,’ says Kerstin Jigmo, resource team doctor and sick-listing coordinator at the district health care centre in the community of Skurup, located at the southern tip of Sweden.
Since 2002, the district health care centre in Skurup has had a special resource team for patients who have been sick-listed for more than four weeks. The team includes an occupational therapist, a social worker, a doctor, a psychologist, a physiotherapist and one representative from the Swedish Social Insurance Agency and one from the Public Employment Service.
In 2007 the centre adopted an action plan to improve the sick-listing process. The results came fast: In 2002, which was the first year that the centre kept statistics, 74 patients were on long-term sick leave. In 2008, the number was 32!
Dare to See and Dare to Ask
However, something was still missing, according to Jigmo.
‘The process lacked a gender perspective. The Swedish Social Insurance Agency’s report for December 2008 concerning our patients who had been sick-listed for more than 60 days indicated that 16 of the 19 individuals were women. With this obvious imbalance in our hands, we saw an opportunity to secure the quality of our services through the SKL initiative Jämt sjukskriven. The knowledge we gained made us start asking questions such as: Are we making the normal troubles of life a diagnosis, and in so doing, are we medicalising women? Or are we underdiagnosing men’s depressions?
‘Are we making the normal troubles of life a diagnosis, and in so doing, are we medicalising women? Or are we underdiagnosing men’s depressions?’
The staff at the centre devoted themselves to a thorough assessment of the centre’s approaches to care, treatment and rehabilitation.
‘We for example discovered that women who have been exposed to physical or psychological violence in a relationship or while growing up often show up at our centre with symptoms such as diffuse pain or diffuse anxiety, which can result in sick-listing and more complicated rehabilitation.’
Jigmo says that we must dare to see and dare to ask.
‘We decided to do it right from the beginning – we’re going to make a gender equal action plan and it’s going to be an active document that we’ll revise yearly.’
She says that experience shows that women and men express themselves differently, which can lead to differences in our approach and treatment.
‘We’re for example not very good at noticing men’s psychological symptoms. Men are for instance more often than women given a pain-related diagnosis despite the fact that they often display the same problems. Women on the other hand are more often asked questions about their social situation. There is a risk that women are rehabilitated based on the social situation and men more based on their occupational role. And we are more likely to ask men about their alcohol habits.’
The Switching of Gender Gave Insights
The set of patient questions used at the centre has now been standardised in the action plan, and every week when the resource team meets to discuss individual patients, each team member gets to reflect over whether the patient would have been treated differently had he or she had the opposite gender. This approach has in many cases led to changes in the treatment of a patient. The gender perspective has yielded many new insights, according to Jigmo.
‘Personally, I have become much better at wearing my “gender glasses” when I see patients.’
‘It has very much been a learning process. Something as simple as gendered statistics is invaluable in order to identify differences, make us think and then fix the weaknesses. Personally, I have become much better at wearing my “gender glasses” when I see patients.’