A Swedish healthcare reform more than a decade ago allowing patients to choose their own doctor has unexpectedly led to widespread discrimination against medics with foreign-sounding names.
"When I was working in psychiatry, a patient cancelled his appointment with me three times because he didn't want to be treated by a 'foreign doctor'," 30-year-old practitioner Navid Ghan told AFP.
"In the end he didn't have any choice, I was the only doctor available. During the appointment, even though he saw that I spoke Swedish without an accent, he told me 'you foreigners, you don't understand anything'," Ghan said.
Ghan, whose name has been changed at his request to protect his identity, is not even a 'foreigner': he was raised and earned his medical degree in Sweden.
"Now my colleagues and I joke about it in the lunch room. The nurses arrive and say 'they cancelled again when they saw your name'."
Since 2010, as part of a broader reform to Sweden's universal healthcare system that opened up primary healthcare to private actors, patients have been allowed to choose their own doctor and clinic.
Prior to the reform, Swedes were assigned a clinic based on where they lived.
But as tensions smoulder over rising immigration in traditionally homogeneous Sweden, the reform has made it possible for patients to refuse to be treated by non-ethnic Swedes.
Sweden has seen its immigrant population double in the past two decades, statistics show, and support for the far-right Sweden Democrats has surged to 20 percent to make it the third-biggest party.
- 'Fair-skinned' -
Lars Arrhenius is the head of Sweden's Equality Ombudsman, a government agency that promotes equal rights and combats discrimination.
He said that choosing a doctor based on ethnicity is a "worrying development".
At the end of March, 1,011 doctors and medical students signed an appeal in daily newspaper Expressen calling on "the responsible authorities to act against racism" in their field.
In July, the country's largest broadsheet Dagens Nyheter published an investigative series exposing the scope of the problem.
Journalists posing as patients who had recently moved to a new city or town called 120 healthcare clinics and asked that their new doctor be an ethnic Swede.
A total of 51 clinics agreed to the request, 40 refused. Only a handful explicitly said the request was unacceptable.
"We have Maria, Sanna and Elsa. Three fair-skinned women," one medical secretary told a journalist.
Gender Equality Minister Marta Stenevi, whose brief includes the fight against discrimination, told AFP the practice was "totally unacceptable", after meeting various actors in the healthcare sector to address the issue.
The head of the Swedish Junior Doctors' Association, Madeleine Liljegren, said clinics often consented to the requests because of "competition between healthcare clinics over patients."
The more patients a clinic has, the more state funding it gets.
- Lack of support -
"The nurses likely think 'I'll agree to their request' -- as shocking and horrible as it is -- just to keep the patient," said Liljegren, noting that some clinics do not have enough patients to stay afloat financially.
Makih Fatelahi, a hospital doctor in the southern Swedish county of Kronoberg whose name has also been changed, says some patients are concerned about communication issues.
"The problem is that they only see your name when the appointment is made. You don't get a chance to establish an in-person contact before you get rejected," the 28-year-old tells told AFP.
The number of cases of discrimination against doctors of foreign origin is not known.
In 2020, more than 3,500 general discrimination complaints were filed to the Equality Ombudsman, 1,146 of which concerned "ethnicity".
Sweden's health care system relies heavily on immigrant workers, who are often employed as nursing assistants. In 2020, 2,401 doctors received medical licences in Sweden, almost half of whom earned their degrees abroad.
Navid Ghan said he doe not feel supported by his superiors, even though they have seen the discrimination he has faced.
Many doctors with foreign names complain about a lack of internal procedures at their workplaces for how to respond in such situations.
"You end up not paying any attention to (the discrimination). I use an algorithm to not let my emotions get the better of me: Does this patient really need my help? If yes, I take care of the patient and ignore the comments. If not, I ask a colleague to take my place," Ghan said.