As a special professor of appropriate care, vascular surgeon Lijckle van der Laan (Amphia) wants to create more space in healthcare for conservative treatments in accordance with the ‘do no further Harm’ principle. Appropriate care is not only about disease,is his starting point,but about health and self -reliance. To take steps in the right direction, everyone is needed.
The challenges in healthcare – aging and staff shortage – strengthen the demand for appropriate care. From theory to practice, he states in his inaugural lecture, only works together: government, healthcare providers, citizens, patients and caregivers. As a workable example of how to achieve appropriate care, he mentions the intensive chronic care clinic in Bernhoven hospital for assessing patients with 3 or more chronic conditions. “Hundreds of unnecessary studies are prevented,” headed a newspaper report about this last December. “This is a wonderful example of practical request of appropriate care,” says Van der Laan. “But now the interpretation of this initiative. A large part of the success is in the knowledge and expertise of the geriatrician. That is why it also has a prominent place in our prehabilitation and screening team. The point is that the geriatrician who plays a role in this gets 1 hour per patient and the medical specialist only wants to take the patient in the first, but is not in the first, but that in the first, but that is the same in the first, but that is what it is in the first time, which is what it is that that is what it is that that is, that is, that is, that is, that that, A wait -and -see policy can be a better choice than operating does not work in 10 minutes. ”
More geriatrists does not seem like the solution, he says. His plea is to set up care for the vulnerable patient in a different way. Translated to: a multidisciplinary team that screens the patient in detail physically and mentally as a basis for joint treatment advice. “To get this done, the current financing system of care will have to change. The current system is in the way of the transition to appropriate care. I am not the only one who finds this. It is becoming increasingly clear that we have to get rid of the PXQ financing if we want to introduce the appropriate care.”
The general practitioner as the first stop
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If Van der Laans plea becomes reality, what is the role of the doctor in it? After all, this is the first professional where the patient goes if he has a demand for care. “That role is very big,” he says. “The general practitioner has the role to chart what the patient’s wish is and how he is in his social context. However, the point is that the doctor also has no more time for this. The result is that we now see more patients with less serious complaints than a few years ago.”
In the ideal world, he says, there would be more time for consultation between the general practitioner and the medical specialist about whether a referral is needed. “This is being experimented with,but in those conversations it is indeed not yet about the vulnerability of the patient and his treatment wish. Training about this would offer a solution to the doctor, but he also runs at the limit of the number of available training hours.That is why I like to tell it at congresses, but I am less often invited.”
Conservative treatment
The plea for a physical and mental screening as the basis for joint treatment advice is a good starting point to offer the step from treatment to lifestyle to conservative treatment. Van der Laan is thus conducting research into the role and effect of what he calls the ‘do no further Harm’ principle. “Now I treat the patient based on his illness and vulnerability,” he says.”I try to come to a prediction model with which I can propose to pursue a cautious policy in the event of a certain vulnerability that the patient offers an equally good result.Or when there is no vulnerability to intervention.” He states that there is no clear limit between appropriate and value -driven care.With value -driven care, the health of the patient is measured through questionnaires about health -driven quality of life. This is complicated for vulnerable elderly people, becuase they often already have a combination of chronic disorders. “We are not yet asking the quality of life very well,” he says. “What someone under 65 experiences as quality of life is very different from what this means for someone over 80. I am very concerned about that, as if I use the classic questionnaire and I do not treat, then the conservative treatment does not offer the patient’s improvement. An older man has to undergo a lower leg amputation.based on the classic questionnaire – with such as:” Do you be able to do you? ” -This amputation is not a good care of that older patient. Longer survival means that they are still born by the loved ones.
Spread and concentration
The quality of life of the older patient must also be taken into account in the discussion about spreading and concentration of complex care, says Van der Laan. “My experience is not being looked at sufficiently now,” he says. “The discussions about spread and concentration are about outcomes and complications.Of course, the treatment of pancreatic cancer must be concentrated in younger patients. But an older patient with a complex aneurysm? Then you will also tax the caregiver.”
There is also another aspect, he adds: “Suppose your norm for a certain treatment is 15 a year and you do 13. Then you will do 2 extra that you should not do based on the starting points of appropriate care? No subject that you can discuss at the regional tables because it is much too sensitive to that for that. Movement is more expensive than before, but now that the process has been set in motion, it is indeed unachievable to stop. “
Change needed
Van der Laan is also a vascular surgery trainer, guides PhD students to Tias/University of Tilburg who are researching the transition of appropriate care and gives lecture to Tias School for Business and Society. “There is a lot of enthusiasm for the subject of appropriate care,” he says. “Everyone is reasing with this problem and wants to get started with it. Everyone also wants to give more attention to prevention. But everyone also sees the problem that it is lacking in the good financial structure for this. If we do not apply the ‘first,do no harm’ principle in healthcare,we will not come to appropriate care. So all stakeholders will not have the classic question lists.”
Appropriate care, from theory to practice
Lijckle van der Laan expressed his lecture ‘Appropriate Care, from theory to practice’ on 14 March on the occasion of the acceptance of the office of special professor of appropriate care. On this occasion he emphasized how critically important it is indeed that his special professorship was made possible by Tias School for Business and Society in Tilburg, together with the Amphia Hospital. “It is a business school. This means that there is knowledge about how to deal with things like leadership, institution, financial strategy and innovation. Key concepts that you really need to achieve change. You do not succeed as a doctor alone.You need all stakeholders in this process.”
