Elderly people who fall between the wall and the ship, young people who are sent from pillar to post. GP Marnix van der Leest is increasingly saddened by how his patients are not getting the help and care they need, even though it is crystal clear that they need it. As a doctor, he struggles with this. Due to fragmentation in healthcare, increased workload and an aging population with different healthcare needs, GPs have less and less time to offer patients the personal attention that is so characteristic of their profession.
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Patients are often the victims of a malfunctioning health care system, says Van der Leest. He cites the example of an elderly woman with a complex psychiatric history as well as many physical problems. “This woman needed a lot of care at home, to such an extent that home care could no longer cope with it. She should really go to a nursing home, but once she was ready to accept that, very few were willing to take her on. This created a harrowing situation, where this lady had nowhere to go.”
“It became an unbelievable headache file, in which no one took or could take responsibility. While at such a moment everything is better than doing nothing. In the end it was solved, but it took far too long. It has caused a lot of unrest and costs with brought before it came to a solution.”
Lots of balls in the air
Cases such as these are also time-consuming for him as a general practitioner, which in turn comes at the expense of time and attention that he can devote to other patients. “I love to spend extra time on patients who need it, but in the meantime the ‘normal’ care continues. There are only 24 hours in a day, and as general practitioners we have a lot of balls to keep in the air.”
According to him, these kinds of struggles are daily practice in general practitioner care. “Many general practitioners experience an increased workload. In recent decades, our range of tasks has expanded and the administrative burden has become much greater.”
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What also does not help is that as a general practitioner you sometimes have to consult with many different parties in order to provide a patient with the right care. “I once sat down with 12 different organizations for one patient,” says Van der Leest. “That is not the intention, that is also not how the government wants it, but it does happen. For example, all kinds of parties work side by side, each working on their own part, and it is extremely difficult to coordinate care properly. .”
Four different mental health institutions
Such as the family with a migration background, where one of the children got into trouble at school. “He could not find his way, which caused him to have psychological problems. Then you are sitting with a family counselor, someone from mental health care, someone from the municipality and various psychiatrists, you see the network growing. Before you know it, the child is with four different mental health institutions and little has changed.”
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Or take the gifted girl who develops psychological problems in her puberty. She is sent from one mental health care institution to another, everyone recognizes that there is a problem, but everywhere it falls just outside the expertise. “Meanwhile, the problems are building up and an almost untenable situation is created at home,” says Van der Leest. “The whole family suffers from it. But only when things get so out of hand that a real crisis arises can she be forced into hospital. These are extreme cases, but they do make it clear what we often encounter in patient care.”
From birth to death
Ideally, the GP in such cases is the spider in the web who coordinates everything, says Van der Leest, but much to his frustration that sometimes just doesn’t work. Because for all the reasons mentioned above, the personal attention that GPs can pay to patients is increasingly under pressure. “As a general practitioner you sometimes follow people from birth to death, that is the strength of our profession, that is the core. It is so valuable that you as a patient are known and seen, that a general practitioner can help you further. But that is now under pressure.”
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Van der Leest wrote the book about all the dilemmas he personally encounters in his general practice and about the beautiful sides of his profession. GP on prescription. On the basis of patient stories, he makes clear how important it is that there is sufficient time and personal attention in the consultation room. “My book is mainly intended to show that general practitioner care as it is organized in the Netherlands is something to be careful with,” he says. “It is a wonderful profession, but we also regularly run into problems and experience several bottlenecks. The core values of our profession – personal time and attention – must not be lost.”
Market forces must go
These are complex problems that require different solutions, says Van der Leest. For starters, he would like to see the administrative burden reduced. He also advocates smaller practices. “But then you will need more GPs to keep the quality care we strive for at the right level.” He also believes that there is a limit to the number of tasks that GPs can take on. “There will come a time when we have to say: we only want to focus on the core. General practitioners are an enthusiastic profession that likes to make an extra effort for patients, but at some point we cut ourselves in the fingers.”
Finally, according to him, market forces play tricks on healthcare. Market forces are about competition, but collaboration is so essential in healthcare. “Contracts with health insurers now guide how we organize our practice. We have become a product. A product that the health insurer purchases and manages with targets on benchmarks. There is always room for discussion, but they have a big finger in the pie. That does not work for the general practitioner, it causes all kinds of problems. That market forces should therefore be removed, because in the end it does not benefit the patient’s care and that is of course what it is all about.”
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‘GP on prescription’ will be published on September 14.
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