Knut Eirik Eliassen

11.05.2026: Kronikk - Det er nok fastleger i landet til å dekke behovet for praksisveiledere, men rammene gjør det utfordrende å prioritere medisinstudenter fremfor leger i spesialisering.

20.04.2026: Invitert kommentar - Tittelen er latin og betyr «Jeg lærer hele tiden, men ikke fra læreren».

Most patients with skin and soft tissue infections (SSTIs) are treated in the primary care setting. However, recent epidemiologic data in primary care are limited. To investigate incidence and patient characteristics of SSTI episodes in daytime general practice (DGP) and out-of-hours (OOH) services in Norway. Registry-based study using reimbursement claims data from Norwegian primary care for the period 2006-2022. SSTI consultations were grouped into episodes, and patient morbidities were identified using a morbidity index. Incidence rates were calculated based on population data from Statistics Norway. During the study period, 1 171 018 unique patients experienced altogether 1 727 736 SSTI episodes in Norwegian primary care. Most SSTI episodes (76.1%) were managed in DGP and incidence rates peaked in the third quarter. The overall annual incidence was 20.0/1000 inhabitants, with a decrease from 23.7/1000 inhabitants in 2006 to 17.0 in 2022. During the period, the largest decline among the SSTIs was observed for impetigo (68.1% decrease), infected wound or bite (46.0% decrease), and cellulitis and erysipelas (23.6% decrease), while abscess and furuncle and paronychia all remained stable. Overall, elderly patients and patients with a morbidity score of one or more had higher incidence rates of SSTIs, that increased over the period. The incidence of SSTIs in DGP and OOH services in Norway declined over the study period, except for elderly and persons with multimorbidity. As the population is increasingly older and multimorbid, such infections may represent a growing challenge in the future.

Background: The COVID-19 pandemic brought a surge of remote consultations in Norwegian primary care with unknown implications for antibiotic treatment and outcomes of acute cystitis. Aim: To examine whether there were differences in antibiotic treatment or repeat contacts for acute cystitis between remote and in-person consultations. Design & setting: A retrospective cohort study was undertaken. For the 4-year period from 2018–2021, we linked individual registry data on all contacts for cystitis by women aged ≥16 years in general practice and out-of-hours (OOH) services in Norway with registry data on dispensed antibiotics. Method: Index consultations for cystitis episodes were identified when there had been no urinary tract infection-related contacts or antibiotics dispensed at least 2 weeks before the consultation. We compared index remote versus index in-person consultations by antibiotic treatment within 3 days and repeat contacts within 14 days. Remote consultations were defined as consultations by text, telephone, or video. Results: Remote consultations for acute cystitis increased markedly, from 0.5% of acute cystitis consultations in 2018 to 15.2% in 2021. Index remote consultations were associated with more second-line antibiotic treatment (adjusted relative risk [aRR] 1.04, 95% confidence interval [CI] = 1.02 to 1.06, P P <0.001) than in-person consultations. Conclusion: For acute cystitis, index remote consultations are associated with more second-line antibiotic treatment and more repeat contacts than in-person consultations. The unique time-period of the COVID-19 pandemic and the regular GP scheme in Norwegian primary care must be considered when interpreting these findings.

Introduction: Clinical workplaces offer unrivalled learning opportunities if students get pedagogic and affective support that enables them to confidently participate and learn from clinical activities. If physicians do not greet new students, the learners are deprived of signals of social respect and inclusion. This study explored how physicians’ non-greeting behaviour may impact medical students’ participation, learning, and professional identity formation in clinical placements. Methods: We analysed 16 senior Norwegian medical students’ accounts of non-greeting behaviours among their physician supervisors in a reflexive thematic analysis of focus group interview data. Results: The main themes were: A) Descriptions of non-greeting. Not being met with conduct signalling rapport, such as eye contact, saying hello, using names, or introducing students at the workplace, was perceived as non-greeting, and occurred across clinical learning contexts. B) Effects on workplace integration. Non-greeting was experienced as a rejection that hurt students’ social confidence, created distance from the physician group, and could cause avoidance of certain workplace activities or specific medical specialties. C) Impact on learning. Non-greeting triggered avoidance and passivity, reluctance to ask questions or seek help or feedback, and doubts about their suitability for a medical career. Conclusion: Medical students’ accounts of being ignored or treated with disdain by physician superiors upon entering the workplace suggest that unintended depersonalising behaviour is ingrained in medical culture. Interaction rituals like brief eye contact, a nod, a “hello”, or use of the student’s name, can provide essential affective support that helps medical students thrive and learn in the clinic.

18.07.2023: Leder - Til nå har universitetene satt sin lit til at allmennlegene tar imot studenter av god vilje og altruistisk interesse og at dette har vært godt nok både for studentene og for legene.

Background: Sleep problems are common in the general population, but there are few studies on the prevalence of sleep problems and hypnotic use among patients in general practice.Objectives: To estimate the prevalence of insomnia (based on the Diagnostic and Statistical Manual of Mental Disorders [DSM], version 5), self-reported sleep problems and hypnotic use among patients in general practice, and explore whether the prevalence depended on patient characteristics.Methods: A cross-sectional study with questionnaire data collected by 114 final-year medical students while deployed in different general practices in Norway during 2020. A total of 1,848 consecutive and unselected patients (response rate 85.2%) visiting their general practitioners (GPs) completed a one-page questionnaire, that included the validated Bergen Insomnia Scale (BIS), questions on for how long they have had a sleep problem, hypnotic use, and background characteristics. Associations were estimated using a modified Poisson regression model.Results: The prevalence of chronic insomnia according to BIS was 48.3%, while 46.9% reported chronic sleep problems (sleep problems of ≥3 months) and 17.8% reported hypnotic use. Females, patients with low compared with higher education, and patients who slept shorter or longer than 7–8 h, had higher risk of chronic insomnia disorder (CID), chronic self-reported sleep problems (CSP), and hypnotic use. The oldest age group (≥65 years) had lower risk of chronic insomnia compared with the youngest (18–34) but twice the probability of hypnotic use.Conclusions: CID, CSP, and hypnotic use were prevalent among patients visiting their GP. Insomnia can be effectively treated and deserves more attention among GPs.

Background: The emergency primary care (EPC) services in Norway have been at the frontline of the COVID-19 pandemic. Knowledge about the EPC services’ management of the COVID-19 outbreak can be used to prepare for future outbreaks and improve patient management. The objectives of this study were to identify pandemic preparedness and management strategies in EPC centres in Norway during the COVID-19 outbreak. Methods: Questions regarding patient management of the COVID-19 outbreak were included in data collection for the National Out-Of-Hours Services Registry. The data collection was web-based, and an invitation was sent by email to the managers of all EPC services in Norway in June 2020. The EPC services were asked questions about pre-pandemic preparedness, access to personal protective equipment (PPE), organizational measures taken, and how staffing was organized during the onset of the pandemic. Results: There were 169 municipal and inter-municipal EPC services in Norway in 2020, and all responded to the questionnaire. Among the EPC services, 66.7% (n = 112) had a pandemic plan, but only 4.2% had performed training for pandemic preparedness. Further, fewer than half of the EPC centres (47.5%) had access to supplies of PPE, and 92.8% answered that they needed extra supplies of PPE. 75.3% of the EPC services established one or more respiratory clinics. Staffing with other personnel than usual was done in 44.6% (n = 74) of the EPC services. All EPC services except one implemented new strategies for assessing patients, while about half of the wards implemented new strategies for responding to emergency calls. None of the largest EPC services experienced that their pandemic plan was adequate, while 13.3% of the medium-sized EPC services and 48.9% of the small EPC services reported having an adequate pandemic plan. Conclusions: Even though the EPC services lacked well-tested plans and had insufficient supplies of PPE at the outbreak of the COVID-19 pandemic, most services adapted to the pandemic by altering the ways they worked and by hiring health care professionals from other disciplines. These observations may help decision makers plan for future pandemics.

Erythema migrans (EM) is the most common manifestation of Lyme borreliosis. Here, we examined EM patients in Norwegian general practice to find the proportion exposed to tick-transmitted microorganisms other than Borrelia, and the impact of co-infection on the clinical manifestations and disease duration. Skin biopsies from 139/188 EM patients were analyzed using PCR for Neoehrlichia mikurensis, Rickettsia spp., Anaplasma phagocytophilum and Babesia spp. Follow-up sera from 135/188 patients were analyzed for spotted fever group (SFG) Rickettsia, A. phagocytophilum and Babesia microti antibodies, and tested with PCR if positive. Day 0 sera from patients with fever (8/188) or EM duration of ≥ 21 days (69/188) were analyzed, using PCR, for A. phagocytophilum, Rickettsia spp., Babesia spp. and N. mikurensis. Day 14 sera were tested for TBEV IgG. We detected no microorganisms in the skin biopsies nor in the sera of patients with fever or prolonged EM duration. Serological signs of exposure against SFG Rickettsia and A. phagocytophilum were detected in 11/135 and 8/135, respectively. Three patients exhibited both SFG Rickettsia and A. phagocytophilum antibodies, albeit negative PCR. No antibodies were detected against B. microti. 2/187 had TBEV antibodies without prior immunization. There was no significant increase in clinical symptoms or disease duration in patients with possible co-infection. Co-infection with N. mikurensis, A. phagocytophilum, SFG Rickettsia, Babesia spp. and TBEV is uncommon in Norwegian EM patients. Despite detecting antibodies against SFG Rickettsia and A. phagocytophilum in some patients, no clinical implications could be demonstrated.