Press Press

Dutch doctors supported by media

BMJ 2000; 321 doi: http://dx.doi.org/10.1136/bmj.321.7262.712 (Published 16 September 2000) Cite this as: BMJ 2000;321:712
  1. Godelieve van Heteren, university lecturer in medical history and freelance journalist, department of ethics
  1. Philosophy and History of Medicine Faculty of Medical Sciences, University of Nijmegen, Netherlands

    British doctors may feel all alone in the trenches as they continue to be hit by a relentless series of scandals in the press. Professional demoralisation, however, seems to be a much more widespread phenomenon, currently affecting many European healthcare settings, hinting at deeper and perhaps more common roots of professional unease. What clearly varies, however, are professional strategies to deal with the media.

    Take the Netherlands. Here, too, healthcare provision has come under fire. But rather than pillorying doctors, most journalists aim their critical arrows elsewhere: at government, insurers, and hospital administrators. In the process, professionals have become the media's best friends, as victims of a failing system.

    This peculiar state of affairs became visible again recently, when one of the senior commentators of De Telegraaf, the most widely read Dutch populist national morning paper, filled a column with his personal selection of headlines on health care from the previous few months (De Telegraaf, 29 July). These included: “Many demented elderly without care” (Haarlems Dagblad); “Shortage of doctors to check up on children” (Tubantia); “Too little radiotherapy available for cancer patients” (NRC Handelsblad); “GPs sick of workload” (Drentse Courant); “A third of GPs will stop this year” (Het Parool); “Pregnant women without midwives” (Noordhollands Dagblad); “Day-budget finished, patients sent home” (De Limburger); and “Waiting lists: an outrage” (De Telegraaf). This avalanche of negative reports allowed for only one conclusion, De Telegraaf maintained: the pending collapse of the Dutch healthcare system.

    Few of the headlines were attacking professionals directly. Doctor bashing has not yet become a national sport in the Netherlands. Professional organisations may be reproached for their guild-like structure (NRC Handelsblad, 13 January), but reports of scandals involving doctors are few and far between.

    To media watchers, De Telegraaf's column—for all its alarmist contents—merely confirmed the profound shift in public perception of health care they have noticed for over a year now. In the past, Dutch commentators could bore an audience to death with barely disguised national pride about their high quality, easily accessible healthcare system—delivered since the late 1980s at the expenditure of a fairly constant 8.5% of the gross national product.

    Today, that mood has changed. There is mounting opposition to the macro-budget policy and the detailed supply regulations, which only allow for an annual volume increase of 2.3%—much too little to keep the system up to speed, critics say.

    Hundreds of critical articles have appeared since the beginning of this year. The primary theme is waiting lists, which prove a bottomless pit, swallowing hundreds of millions of government guilders to no avail. “Waiting lists for hospital care grow again,” the Dutch Press Agency ANP announced in June; a “millstone around health minister's neck” (Financieele Dagblad, 16 June).

    Another recurring worry is the loss of healthcare staff to the private sector and the business world (“Professionals flee, but where?” De Telegraaf, 13 May), a situation worsened by the increasing numbers of reports on demotivation and significantly higher sickness rates in the healthcare sector (8.7% instead of the national average of 5.6% in 1998; Parool, 14 June). Last year MOVIR, a healthcare personnel disability insurance company, barely escaped bankruptcy due to the rapid increase of burnout among health practitioners. Fellow disability insurers were reported to have raised their annual premiums by up to 25% to cover the high percentage of healthcare workers falling ill under growing work pressures.

    Figure1

    “Dead on the waiting list”

    Also hitting the headlines are the shortages of staff reaching critical levels in several disciplines: “GP shortage plagues provinces” (Elsevier, 17 June), “Medical care no longer guaranteed, due to lack of GPs” (Volkskrant, 26 June), “Major shortage of gynaecologists in Alkmaar” (Reformatorisch Dagblad, 5 July).

    So, while the recent World Health Report 2000 still ranks Dutch health care in the top 20, the Dutch press has pronounced a national crisis in health care. And the professionals? They have jumped on that bandwagon. Many have abandoned their traditional reluctance to spill the beans in the press. Much to their own surprise, their coming out has been warmly embraced by most of the Dutch media.

    The year had barely started when one national morning paper carried an article by a general surgeon Ton van Engelenburg cautioning government and health insurers against strangling the profession and saying that one out of five doctors were dissatisfied with their work and regretted ever having chosen medicine as a profession (Algemeen Dagblad, 5 January).

    In April and May, the weekly Vrij Nederland published a reportage series covering the daily struggles of healthcare practitioners of the Utrecht Academic Hospital. The prestigious evening paper NRC Handelsblad had plastic surgeon Hans de Bruijn explain how structural lack of funding and chaotic legislation prevented professionals from doing their job and caused the system to grind to a halt (22 January). His colleague Chris Plasmans, chairman of the national organisation of orthopaedic surgeons, was given free rein to complain about the urgent need of extra staff in his field (Algemeen Dagblad, 15 January).

    The climax of the outpouring of doctors' sorrows was a full page interview with staff surgeon Maurits de Brauw of the Maastricht Academic Hospital, detailing his reasons for leaving the profession after 20 years of faithful duty: “I make people sicker, not better” (NRC Handelsblad, 27 May).

    Thus, in the Netherlands, a curious alliance has emerged which—at least for now—holds professionals and media in an unprecedented union. All keep their eyes firmly on the Department of Health, where Minister Els Borst has assembled the heavy artillery, a task force to help her produce an official plan on the future of the Dutch healthcare system for the Cabinet by December.

    In a country with coalition governments and a mixed public-private insurance system, any change in health system legislation is bound to be a thorny affair. Senior civil servants remember all too well how the attempts at health reform in the early 1990s failed. Their anxiety about the current mood of the media is understandably mounting.

    Most newspapers seem unimpressed by the government-friendly experts who emphasise that a silent revolution is in fact already underway, resulting in a greater convergence of private and public arrangements and increasing flexibility.

    Such experts do not convince ordinary Dutch citizens either, who have to wait five months for a hip replacement or eight weeks for biopsy of a breast lump. For them, tacit revolutions are simply not good enough. And these days, they find the medical world and the media on their side.

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