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‘Euthanasia? Wednesday at the end of the day, we’re a bit tight’

Friday only? No, no, the kids shook. Their father hoped last week that his request for euthanasia would be granted. Still four more nights to wait? That’s actually not possible.

General practitioner Gijsbertjan van Breukelen looks at the ceiling. “Hmm.” He is sitting next to the bed of a 76-year-old man, the whole week’s planning rattled by in his head. Which appointments can he cancel? And will the general practice in Woerden get into trouble?

“Wednesday might be an option,” he says. “At the end of the practical day. In all honesty, we’re tight.” The man, his wife and children nod in agreement – ​​Wednesday is better. “You also need time to say goodbye,” says Van Breukelen.

The GP explains step by step how euthanasia works. First a nurse comes to insert an IV, then, among other things, a sleeping aid is injected. The sun shines in through the soft yellow curtains.

At the bottom of the exit, Gijsbertjan van Breukelen approaches the coordinator of the hospice. Deep wrinkles appear on her forehead when she hears the schedule. Wednesday night? She sighs. They’re tight. That will be a puzzle.

The GP nods and walks back to the practice with giant strides. Friday is his day off. He thought: then I have all the peace of mind to grant this request. Van Breukelen throws his coat on the coat rack and flops down on his desk chair. “But if you’ve decided that someone is suffering unbearably, you can’t really say: just wait until Friday.”

He punches in the pharmacist’s number. She promises to prepare the ampoules on Wednesday morning.

Van Breukelen actually has a meeting on Wednesday evening. Healthcare in Woerden is coming to a standstill. A GP practice must be added, but who will take on that task?

He is now canceling that meeting. “No time!” he laughs. “How cynical is that?”

Almost all general practitioners in the Netherlands experience the same problems as the general practitioners in Woerden. There are too few doctors, too many patients. And now that the flow of patients has stalled in hospitals, mental health care and care for the elderly, these patients are repeatedly put on the GP’s plate. What do the problems look like in practice? An average day in the life of Gijsbertjan van Breukelen (41), a general practitioner at the Kievitstraat in Woerden.

8.05 am

Team discussion at the oval wooden table on the first floor. General practitioner Esther de Graaf has a cancellation during her consultation hour. That means a little leeway for the five assistants who answer the phone today.

The weekly schedule of the practice hangs on the wall. There is a red dot behind four of the five GPs: their consultation hours are fully booked.

Van Breukelen gets up and, two steps at a time, goes down the stairs to his consulting room. “It’s raining bad diagnoses,” he says. “A lot of cancer. You think: have people waited too long?”

8.30 am

The first patient, an elderly woman, had the flu. She is concerned: she needs to be anesthetized, but that is not happening. Is it too busy in the hospital? “They were almost late last time too.” Van Breukelen knows her well. Specialists see a narrowing in a vein, he explains, they will do an MRI scan and then decide what is needed. “They should have explained that to you.”

9.20 am

A man in his 70s, sporty figure, suffers from “flaky stools.” He used to go once a day, now he sometimes doesn’t even make it to the toilet. Van Breukelen nods – “not a nice turd”, he types. His pants are falling, the man notices. He has lost six kilos in a few months. He hopes for a pill. A pill? “We cannot escape a bowel examination,” says Van Breukelen. But where? He scrolls over a screen with the waiting times per hospital. “Pooh,” he sighs. Woerden: ninety days. Nieuwegein: ninety days. “How mobile are you?” In Bilthoven, a private clinic will be available within a week. “The disadvantage,” says Van Breukelen, “if they find something, they won’t treat you. Then you will come back to me.”

10.05 am

One of the assistants is peeling an apple on the roof terrace. When she started her shift at a little past eight this morning, there were already fifteen people in the telephone queue. The waiting time was up to 40 minutes. “And we only had seven spots left in the consultation hour.” You can guess what the mood was on the other end of the line. A colleague: “Basically, it is your job to keep people away from the office hours. Nine times out of ten, complaints will go away on their own.”

Also read: ‘Patient stops in four cities due to a shortage of general practitioners’

The practice on the Kievitstraat in Woerden has 8,300 registered patients, and seven general practitioners during normal times. But now there are two vacancies, and one colleague is on vacation.

The assistant: “At a practice near here they don’t even answer the phone anymore. There you will receive a wristband: you can only come by for urgent matters.”

Van Breukelen believes that people should be able to see a GP within three days – and that they have the right to a permanent GP. It provides scientifically proven health benefits, he says. There are already areas where people are without a doctor – areas where people are often already vulnerable. “You get a gap,” he sees, “people with low health literacy get out of the picture.” These are people who do not know what healthy behavior is, for example. “A colleague from Utrecht recently asked: ‘Do you eat vegetables?’ “Uhh…yeah,” said the patient. ‘Paprika chips’.”

11.15 am

A man with a sore calf slumps into a chair opposite the doctor. He thinks of a whiplash. Van Breukelen thinks so too. “Can you stand on it?” He can. “If you are sitting, you may raise your leg a little higher.”

11:30 a.m.

A woman who has been sleeping very badly since the menopause reports. She has been here many times and has tried everything. What knob can she turn now?

“You can function well on a few hours of sleep,” says Van Breukelen. It’s kind of part of getting older. “People usually suffer more from the frustration of lying awake than from the lack of sleep itself. You have to avoid getting angry.”

The woman may try an antidepressant – in a low dose it can help with insomnia.

When the woman is gone, the GP answers a few questions that came in via the website. They have been doing such e-consultations for a year now. “A boy with eczema on his feet,” he murmurs – he gets an ointment. “In ordinary times you would like to see such a boy. Now I think: he is young, if this doesn’t work, he will find his way to the doctor.” Is this the new concern, Van Breukelen sometimes wonders, “or are we taking an unacceptable risk?”

Gijsbertjan van Breukelen has been a general practitioner since 2008. Almost all patients who queue today know him. At least half know that he became a father three weeks ago. And: the GP knows them. He knows what the woman with chest pain is afraid of, and that he should take a little more time for the man with vascular problems.

Before calling someone into his consulting room, he reads the reason for the appointment, then walks into the waiting room. He observes how they sit, their color, their smell, how do they bounce out of the chair? Nine times out of ten he already knows what he is going to do for the patient. And today seven times out of ten it was nothing: nothing with the boy with stomach problems (he has to take less antacids), nothing with the man with the whiplash, nothing with the child who wets the bed. He listens, explains, gives advice. He calls it “social medicine.”

Sometimes the GP does something because the patient wants it: a blood test to detect prostate abnormalities, for example. Van Breukelen finds ‘unburdening’ also ‘quality of life’. And by the way: “You can say: you don’t have to come to me with such questions. But I still have to go through one door with that patient.”

12.15 pm

Mail from the assistant: a baby with a fever for three days, can he still get in? Van Breukelen: “I want to see it.”

1.10 pm

Lunch on the roof terrace, without Van Breukelen. The number of phone calls is now decreasing somewhat, the assistants say. In recent corona years, the telephone has been busier than ever. When the NOS reported that people between the ages of 60 and 64 could get a vaccination, half the patient population was on the phone the next day. “Why were we not informed a little earlier than the NOS?”

A lot of care bounces back on the GP, says one of the doctors who has also joined. Removing a suture after a hospital visit. “Or the doctor says after the operation: you can always call.” She laughs: “But such a patient will of course never get that doctor on the phone again. The hospital operator says: call the doctor.”

1.40 pm

Van Breukelen pours a glass of cola and snatches a roll of biscuits. His lunch break was spent on a meeting.

2.30 pm

The baby with a fever has a double ear infection. The doctor prescribes antibiotics. He then calls a young woman whom he has referred to a psychologist. “How are you?” If he has hung up: “The second line in mental health care has all but disappeared”, the care that requires a referral. He sometimes doesn’t know where to go with a patient.

Also read: how Quin Dokters causes unrest in patients

Van Breukelen pulls his coat off the coat rack to go to the hospice. He used to make five visits a day, now a maximum of three, but usually less: the threshold has become higher. Since last year, a consultation hour has been added in the nursing home further down. That makes a difference, he thinks. “Some people just want to see you more often.”

4.15 pm

Back from the hospice, Van Breukelen opens the sliding door of his consulting room. He picks up a woman from the waiting room. She has corona, but also COPD, so he wants to see her. The amount of oxygen in her blood is low, and she has a fever. “Can you make it?” he asks.

4.55 pm

The last patient has left. Two more phone calls, five e-consultations, preparing for euthanasia, and reading 86 letters. Letters from doctors who performed treatments, results, letters from insurers – he will read them tonight.

And then today was quite a relaxed day, concludes Van Breukelen. Not a trace of irony. “I was constantly in control.” He performs almost all tasks besides office hours in his spare time. There has always been a shortage of time in this profession, he says, he knew that in advance. “What’s new is that doing something extra during working hours is never an option again.”

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