The Nordic congresses of general practice: a gateway to a global treasure?

Nordic general practice is something to be proud of. Our doctors are well educated and competent. Furthermore, Nordic medical care stands on rather unique ideological grounds, seen from a global perspective: an ambitious social contract characterized by uniform public funding, solidarity, and equitable distribution of services [1 6]. The Nordic medical systems show many similarities with the British National Health Service (NHS) and also the healthcare models in a handful of other countries. But it is a sad fact that the combination of public funding, solidarity, and equity may be about to become extinct in a world where healthcare is ever more often considered a commodity [7]. Under the pressure of globalization and market forces, even Nordic doctors are facing an increasingly demanding task when trying to transform high political ideals into practical reality [1,3 6], and although some may wonder whether ‘‘the Nordic model’’ is about to become an outdated ideal, we believe that it is a system worth fighting for. When saying so, we are not alone: Referring to the NHS, US medical quality expert Donald Berwick recently stated that a medical care system that is based on a combination of moral intent , commitment to equity, and a store of knowledge can be considered ‘‘not only a national treasure; it is a global treasure’’ with the ‘‘inherent capability to become the greatest healthcare system of any nation’’ [8]. That context surrounding Nordic general practice can be regarded as particularly favourable for the development of prudent, high-quality medical practice. On the one hand, the Nordic welfare systems are rich in resources, by international comparison. But on the other hand, our doctors are constantly exposed to demands for cost restraint and increased effectiveness. They carry the responsibility not only for the welfare of their individual patients but also for the sustainability of the welfare system as a whole. This can lead to clinical and ethical dilemmas in daily practice, and become a source of working stress. But we have also observed that doctors who become trained systematically in considering the individual good in light of the common good develop an eye that is particularly apt at discerning simple, attractive, and responsible ways to practise medicine. It is hard to imagine the cultivation of such a critical mindset in medical contexts dominated by unequal distribution of resources and market forces. During recent years, Nordic general practice has shaped many creative and innovative doctors with strong professional integrity. They take few things for granted, are ready to challenge old truths and authorities, and see it as part of their job to reconsider the nature of prudent, cost-effective and responsible healthcare. They have thus contributed a significant amount of high-quality research, teaching, and professional development. The mindset and know-how of these Nordic GPs is likely to be of interest to a wider, international audience. A generation of pioneering doctors developed the field of Nordic general practice in the 1970s, driven by the conviction that any sensible healthcare system should be based on primary healthcare. This same view gained international appraisal through the Declaration of Alma-Ata in 1978. The first Nordic Congress of General Practice in Copenhagen in 1979 was a direct and tangible result of the pioneering enthusiasm and creativity among Nordic GPs [9]. An overview of subsequent Nordic congresses can be seen in Table I. The purpose of these congresses was to strengthen the network and identity among Nordic general practitioners, and to facilitate research, teaching, and quality development within the Nordic countries. In the beginning, the congress language was ‘‘Scandinavian’’, referring to Danish, Swedish, and Norwegian, which are quite similar languages. The use of the Scandinavian tongue strengthened the sense of a distinct Nordic identity but implied a certain disadvantage for participants from Iceland and Finland. In 2002 an important milestone in the history of the Nordic congresses was passed at the 12 Nordic Congress in Trondheim, Norway, when the organizers for the first time challenged the plenary speakers to present in English [10]. Another interesting feature of this congress was the way the organizers highlighted critical professional thinking. They focused systematically on what they perceived to be an inherent tension between a traditional biomedical Scandinavian Journal of Primary Health Care, 2006; 24: 196 198