Inappropriate use of hospital emergency departments

To the Editor: I was interested in the letter by Marks et al,1 indicating that the efforts of over-worked medical staff in emergency departments to introduce patients to local general practitioners had been largely unsuccessful.

A few years ago I noted the success with which this problem was handled by the emergency department management at Huddinge University Hospital in Stockholm. All patients were charged 60 krone at triage. Those who sat in the waiting room were confronted by two large electronic signs. The first listed the waiting time for the 10 most common GP-type ailments. The second listed 10 local GPs, where the consultation fee was then 50 krone, with the offer to refund their initial payment if they chose to take their business elsewhere. I was told that this was the very successful first of eight "barriers" between the emergency department door and the intensive care unit.

Since the middle of last century, Sweden has been held up as a model provider of an egalitarian and "free" healthcare service. Perhaps our country could benefit from the revisions and improvements that the Swedes have made over recent decades.