"Financial considerations should not be part of the discussion between patients and their treating physicians"

We interviewed Ate van der Zee and Liesbeth de Vries about their study & career and weighing the cost of treatments and value for patients. And their advice for FEB students.

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1.   Where and what did you study? Why did you choose that programme?

Liesbeth de Vries: I studied medicine. First, I wanted to become a nurse but once I realised at high school I could be a doctor I wanted to become a doctor.

Ate van der Zee: For me it was more or less the same, except for the part about becoming a nurse. I have wanted to become a doctor since I was a child, probably related to the fact that my dad was a general practitioner.

2.   How do you look back on your student days in Groningen?

Ate van der Zee: My student time was great. In my time studying medicine was more simple. As long as you passed your exams it was fine. There weren’t that much tutorials and practicums as there are nowadays.

Liesbeth de Vries: I had a good time as well. I was a member of Vindicat back then and I believe that taught me to understand other people when I was in training for internal medicine.

3.   Could you tell us something about your own career and how you got to where you are now?

Ate van der Zee: During my studies I didn’t really know what specialisation to choose yet and during my internships I very much liked all the different rotations. Everything seemed interesting to me. In those days it was quite difficult to get a position to specialise and in the end I applied for a position in the Department of Obstetrics and Gynaecology and I could start there almost immediately. Then, after having worked on an oncology floor, I decided I wanted to become a gynaecological oncologist. As a part of that choice I also started to do oncology research, together with Prof. de Vries actually.

Liesbeth de Vries: I postponed my decision for a long time and in the end I chose internal medicine over paediatrics because it would provide me with more opportunities. Even during my training in internal medicine I had not expected initially that I would be in oncology now. Also because that specialisation hardly existed back then.

4.   Have you heard of the work of Machteld Huber about the new concept of ‘being healthy’? She explains health as the ability to adapt and to self-manage, in the face of social, physical and emotional challenges. What is your opinion on this?

Ate van der Zee: Yes, of course I have heard of her work and its significance lies in her broader view of what is healthy for people.

Liesbeth de Vries: I probably would like to rephrase her wording of being healthy to being happy.

5.   Treatments for certain diseases can be rather disproportional sometimes. Do you think the value for the patient always outweighs the cost of treatment?

Ate van der Zee: The word always allows for an easy answer…. However, in general a doctor and a patient should together carefully weigh the different pros and cons of a possible treatment. It is upon the doctor to ensure that the patients gets such information that a balanced choice can be made. Financial considerations should not be part of this discussion between patients and their treating physicians in the doctor’s office. Financial issues need to be decided elsewhere by appropriate bodies such as professional societies, patient representative groups, hospital boards, politicians, etc.

Liesbeth de Vries: The value for the patient may not always outweigh the cost of treatment. But this is not an easy subject as people in general love to live. The clinical benefit of treatments do vary and having excellent insight in the clinical benefit of for example expensive drugs, makes it easier to make proper decisions with the patients. My European Society has developed a scale to support decision making with regard to new, often expensive, cancer drugs.

6.   Do you have any advice for the students at the FEB?

Ate van der Zee: Don’t worry too much about what to do best for your career, but instead learn to know what really makes you tick.

Liesbeth de Vries: Follow your interests, enjoy what you are doing, have a broad interest.