Patients in Sweden received fewer post-op opioids. Why is that?

When I was in Sweden, I heard this phrase several times: “There is no such thing as bad weather, just bad preparation.” They said this when we asked them what they did with their children in dead of winter. The proud parents made it very clear that no matter what the weather, when it is time to go outside for recess at school, or to get out of the house on the weekends, everyone bundles up and out they go.

For Americans who worry about the lazying effect of socialism, or at least the effect of the democratic social welfare state Scandinavian countries, the Swedes gave a great example of other ways they can encourage resilience in challenging times.

It was no real surprise to me the findings of a study looking at opioid use in Sweden vs. the U.S. (and Canada) following four common surgical procedures: lap choles, lap appys, arthroscopic meniscal repairs, and breast lump excisions. I won’t report all of the findings here, but the bottom line is that Swedish patients received opioids 11 percent of the time, Americans 76 percent of the time (and we were a bad influence on the Canadians at 79 percent).

Do Swedes have fewer nerve endings? Of course not. Did they drink themselves numb? No, their alcoholic drinks are crazy expensive. Is it so cold they just can’t feel anything? Doubt it. Their heaters worked really well.

One of my chronic frustrations with the business/pundit class of critics, when they complain about the overuse of anything in the U.S. health care system, is they blame the doctors/hospitals 99 percent of the time. This Swedish case study is a great example that for less inappropriate use to occur, patients have to be bought in.

I guarantee you the post-op Swedes hurt after the surgeries, just like Americans. The difference is they didn’t expect a pain-free experience the way many American patients do. Just like it is important to them as a point of pride that they are tough enough to defeat bad weather, one can read between the lines that many of them are just as determined to defeat post-op pain with grit and resilience. It takes both the patients and the system to achieve this laudable non-opioid outcome.

Besides, why treat pain with opioids, when it could be treated with a cozy blanket, a fire, and a cup of coffee. It’s Fika time!

Richard Young is a family physician who blogs at American Health Scare.

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