‘Being healthy or unhealthy is not an individual choice, but has to do with the situation you find yourself in.’

You are a professor of general practice. Just like the work of a GP, this field is very broad. What does your team focus on in research?

“It is indeed very broad, but our priority is research for people who need it most. At the Health Campus, for example, we study how to reduce health inequalities in society. We also look at sustainability and climate justice. In our department, we do a lot of research regarding older adults. In addition, I specialize in sex and gender differences, including women’s health. This year, we started a large study on women at increased risk of cardiovascular disease because they experienced preeclampsia during pregnancy. There is a guideline that says these women should be seen more often, but in practice this happens too rarely. What do women themselves need? And how do we ensure that GPs actually do this? Those are the questions we want to answer.”

“At the same time, we also take a broad view. In Leiden, we pay special attention to common conditions, previously called ‘minor ailments’. Despite their prevalence, there is still too little research on them. This means that GPs sometimes make decisions that carry risks. With our research, we want to increase knowledge in this area. For example, our PhD candidate Roeland Watjer studied the effect of antifungal nail polish. With these studies, we can help many more people even better.”

Your inaugural lecture is titled ‘Fight for Health’. What is the message you want people to carry with them?

“That although we have a healthcare system that is accessible to everyone, in practice this is not the case for all groups. This is partly because we simply do not know enough about certain groups. Take women, for example. Even though care for women is accessible, they do not always receive the care they need. The same goes for people with psychiatric problems, for instance because of long waiting lists. And there are many more people, in the LGBTQ+ community; people with a migration background; people with post-COVID or obesity, who do not receive the best care.”

“In my lecture, I will discuss in more detail whether it is a coincidence that these are often groups with stigma attached. I do not think so. I believe there is an underlying layer: we (unconsciously) have opinions about these patients or find them difficult. We need to acknowledge that and act on it. How do we do that? In the consultation room, but also in research. If you only look at English-language studies, you have a very Western perspective. You might learn a lot from a study in Korean.”

“This also applies to education. Doctors from lower socioeconomic backgrounds, or with other differences, notice they are assessed differently and sometimes do not even get into a study program. I believe that if you have doctors from diverse backgrounds, you can also treat patients more diversely, which helps reduce health inequalities. That is the fight for health I mean with the title of my lecture.”

Your social engagement really stands out here. What motivates you?

“I think it is very personal. My parents had the chance to study, which was not a given for them. Because of that, I grew up in a privileged position. We know that people in neighborhoods with low socioeconomic status live up to 25 years longer in poor health. That is shocking when you think about it. Being healthy or unhealthy is not an individual choice, it depends on the situation you are in. As a GP, I see how this injustice plays out. It has a huge impact.”

You also advocate for more knowledge among medical students about careers outside the hospital. Why is that so important?

“When I was studying medicine in Leiden, the focus was still very much on hospital specialties. So it is logical that as a student you only see those role models and do not know what else is out there. Fortunately, career orientation in medical education is now much broader. Students can learn more about working in, for example, nursing homes or youth health care. Our department coordinates theme weeks on career orientation. There is also a national campaign, ‘Next Level Doctor’, which introduces students to career options outside the hospital.”

“The most important thing is that students can make an informed choice. Not everyone should become a GP, of course, but it is much better if you know early on what is out there. If you meet an addiction specialist, youth doctor, environmental health physician or forensic doctor earlier, you can really see if it suits you.”

What has been the best moment in your career?

“Actually, all the choices that led to the realization that I really wanted to become a GP. During my internships, I discovered that I wanted to work outside the hospital. When I worked in a great GP practice with a fantastic trainer, I was sure this was right for me. Those moments are very important.”

“I still laugh when I think back to the moment I told my family I was going to do GP training. My mother’s first reaction was: ‘GP? But you were such a good student!’ That says a lot about how people used to view general practice. It was not always seen as a full medical specialty. More than 50 years ago, if you graduated from medical school, you automatically became a GP. Fortunately, that image has changed. We now treat many more patients in primary care and have our own guidelines and collaborations.”

“It is also remarkable that hospital specialists now sometimes refer patients with complex care needs to GPs. They say the GP knows much better what is going on in the patient’s life. They appreciate our input. The complexity of the disease belongs in secondary or tertiary care, but the complexity of combining diseases, psychosocial factors and the patient, that is something GPs handle very well.”

If we could dream, where would general practice be in 10 or 15 years?

“I hope we continue to focus on person-centered, generalist care that takes people’s context into account. So that three people with the same symptoms leave with care that fits them personally.”

“I also think that in the future, work in GP practices will revolve less around the GPs themselves and more around the whole team, for example: nurse practitioners, physician assistants and mental health support workers. It is teamwork, and that is becoming more visible. I also think we will collaborate much more with other organizations, social work, the social domain, nursing, hospitals, and so on. And speaking of hospitals, I hope we will have staff working both in hospitals and GP practices. That way, knowledge is shared more effectively between the two. This connection between specialties is crucial to understanding what is happening in groups of people and what help they need.”

The inaugural lecture by Hedwig Vos, ‘Fight for Health’, will take place on 21 November and can be followed live via the livestream on Leiden University’s website.