Hygge

April’s special issue of InnovAiT on global health was a reminder of how we learn about our general practice from general practice in other countries. We can feel smug if we look at countries with less developed primary care. However, we might learn more and start feeling sorry for ourselves if we look at countries with better general practice and happier GPs. Or should we, as Nada Khan suggests, all move to Denmark (Khan, 2023)?

The word ‘hygge’ is a Danish term, ‘a quality of cosiness and comfortable conviviality engendering contentment or wellbeing’ and a finalist in the Oxford Dictionaries’ 2016 ‘word of the year’ shortlist. Many books have been published on hygge, including ‘The little book of hygge’ from Meik Wiking of the Happiness Research Institute in Copenhagen. These books remind us that Danes may well be the happiest people in the world. Danish GPs, not to be left out, are bathed in hygge and the happiest of GPs according to a survey of job satisfaction (Stobbe et al., 2021). What can we learn from Denmark?

In the UK, colleagues express dissatisfaction and the reasons for this are all too apparent in our daily work and in the media. It might come as no surprise to learn that UK general practice is no longer smug, no longer the envy of the world, if indeed such an assertion was ever made or meaningful. We can feel better about ourselves when we consider those less fortunate, but it is human nature to make comparisons with the better off and to feel unhappy! Nada Khan reports that Danish general practice, according to Professor Jens Sondergaard, a GP and researcher from the University of Southern Denmark, is thriving; a ‘primary care utopia’ (Khan, 2023). Professor Sondergaard outlines six main reasons for this, one being a government that listens to GPs when designing primary care policies; a feeling of ‘hygge’ between GPs and the government engendering a feeling that policy reflects what is happening at the coalface. Listening is all very well, but the policy design needs to make sense and reflect what has been heard. The other five reasons given for this Danish success story include good salary and payment systems, collaboration and respect from secondary care colleagues, a mature digital health ecosystem, protected time for research and quality improvement and robust education standards. In which of these areas do we fall short?

At the coalface there are problems with our primary care policies. For example, the introduction of physician associates (PAs) has been held as a verschlimmbesserung: an attempted improvement that will make things worse (Zigmond, 2024). Like with so many such attempts, when not making sense at the coalface, there are unintended consequences.

This issue of InnovAiT takes us, not quite from the cradle to the grave, but from pre-conception to post-mortems, with some hallucinogenics along the way. Joshua Getty and Akinsola Akinpelu update on the management of chronic obstructive pulmonary disease, another area where guidance has changed with benefit for patients. Raju Haque et al. provide an interesting look at the use of hallucinogenics in medicine with some surprising insights. Muataz Khalid and Ahmed Elhamalawy offer a review of osteoporosis and remind us of how we should be identifying patients for preventive treatment. Katie Fullerton outlines pre-conception counselling and the role of general practice. Owen Hibberd et al. describe the causes and clinical features of bacterial meningitis, a much-feared disease requiring prompt recognition and treatment. Benjamin Stevens updates us on the different types of post-mortem with information helpful when counselling relatives and the bereaved.

How about a trip to Copenhagen? By the time this reaches you, we may be embracing ‘hygge’, learning Danish and looking for jobs in Denmark. Or will UK contract negotiations have improved things? Will government be listening to GPs at the coalface? Will any of the six reasons for high levels of job satisfaction and hygge in Denmark have been given more attention in the UK? If you can enlighten us on general practice in Denmark and what we might change to make our jobs more satisfying, then please write something to share some robust education and some hygge. We want to achieve better levels of job satisfaction, feel happier and even, dare we dream, smug again. If we ever did.