“The work of a doctor is best in sparsely populated areas”

Elise Kosunen, Professor of General Practice, says that a general practitioner must be genuinely interested in people’s lives. “Doctors also need very good clinical skills, but you will not do a good job unless you have the right attitude.”

Elise Kosunen teaches students to encounter patients as individuals

 “You have to stay in the same place long enough before you can see all the benefits to the general practitioner’s job,” says Elise Kosunen, Professor of General Practice at the University of Tampere.

According to Kosunen, it is best to work as a doctor in sparsely populated areas because a doctor can do many different things there and “the range of life is more varied”. When a doctor gets to know the locals, i.e. the patients, it opens up new dimensions in the job. If you only work for short stretches, you will not get to experience all the good sides.

The problem is that there are not enough doctors who want to work in the more distant parts of the country. Apart from doctors, these areas also lack other medical professionals.
In 2015, the intake of medical students will increase at the University of Tampere. Kosunen believes that the lack of doctors will not be such a serious problem in a few more years.

“The urban lifestyle is more attractive, but luckily there are always those, too, who feel at home in the smaller places.”

A patient is a personality

A general practitioner must be genuinely interested in the patients’ lives.

“Very good clinical skills are of course always needed, but the doctor must also have the right attitude.”

Kosunen has worked as a general practitioner in health centres in different places, lastly as the chief physician at Ylöjärvi health centre. She returned to the University of Tampere in August 2012 when she was appointed a professor.

Patient-centred care is an important theme in the education of doctors. The starting point is to encounter the patient as a person who is much more than just a patient.

“The person’s conceptions, beliefs, personal characteristics and environment all play a role in how the patient can be treated and how she or he can commit to the treatment.”

If we think of long-term illness and a patient who goes to the doctor or nurse once a month, there are still 353 days in the year when the patient treats her/himself, i.e. decides what to eat, how much to move and how to take medication.

“In order for the treatment to be effective, you have to have good rapport with the patient. You do not just prescribe treatment, you negotiate the possibilities,” Kosunen says.

“It is clear that not all patients are ready yet to make this kind of a commitment and bear the responsibility for their own treatment. However, that will happen in the future.”

Medical care goes electronic

When they age, today’s young people will be different kinds of patients than the present-day grannies in their country homes. The young people have the skills to use electronic services: They are able to use internet resources for self-treatment, for example noting down home test results. The doctor can use this information when she or he prescribes treatment.

In the Finnish Student Health Service (YTHS), for instance, it is already common practice to take care of some things electronically.

“The change in practices will one day come to concern all health care,” Kosunen believes.

Interaction brings results

More courses on interaction have been added to medical training in recent years. According to Elise Kosunen, these courses are one of the nicest ones to teach. The students conduct patient interviews in small groups, the interviews are videoed and watched later on. Voluntary patients come from patient organisations.

The doctor’s bedside manner has a direct effect on how the patient’s self-treatment succeeds.

“This issue is also interesting from the research perspective because so far not much is known about what the patients think about self-treatment,” Kosunen says.

She says that the current students are committed and talented. Dropping out is rare.

“Like the whole Finland, the students have become more open and they have better interpersonal skills.”

Text Tiina Lankinen
Photograph Jonne Renvall
Translation Laura Tohka

This story was originally published in Finnish in Aikalainen 4/2013