Peter Paul van Benthem and the Covid whirlwind
Peter Paul van Benthem is not only head of the ENT department at the LUMC but also chair of the Federation of Medical Specialists. ‘The value is in the mix.’
‘I think that the medical specialists have shown great medical leadership.’
Ask Professor of Otorhinolaryngology Peter Paul van Benthem (59) about his other position as chair of the Federation of Medical Specialists and you’ll be swept up in a whirlwind of thoughts and stories – mainly relating to the events leading up to the outbreak of coronavirus. ‘From a medical perspective the pandemic has been a particularly interesting time, right from the outset,’ he says. ‘Fascinating times.’
Since the start of the coronavirus crisis, the Federation has been doing all it can to pass any information about the virus on to its members, in free webinars, for example. ‘We’ve immediately shared every snippet of information,’ Van Benthem says. ‘Once it became clear that chloroquine isn’t useful for treating people with Covid, we told our members straight away in a webinar that was attended by thousands of specialists. This meant we could dispel people’s doubts about whether or not to use it. The same was true for dexamethasone, which has been found to be useful. The Federation also published emergency guidelines with all that we knew thus far, from information on therapies to PPE protocols. There was a huge need for these guidelines because to begin with everyone was doing their own thing. The guidelines were obviously revised as soon as new information became available. With the help of ZonMw and the Ministry of Health, Welfare and Sport (VWS), we also started a national Covid-19 research programme.’
He takes a breath. ‘I think that the medical specialists have shown great medical leadership. Medical leadership is incredibly important. It can be given expression in all sorts of ways, from helping organise things for individual patients to using your influence in politics. The Federation joins various crisis teams. As its chair I attend a meeting with a team led by Minister van Ark every Monday.’
It sounds as though you’ve thought of little else than coronavirus this past year.
‘I have to say, particularly during the first wave, when everything was happening so fast, we didn’t yet understand the disease and didn’t know how it would end, when all we saw were those terrible pictures from China and Italy... then we were working day and night. Everything was new. I’ve never worked so hard in my whole life. It now feels as though we’ve got more of a grip on the disease.’
You are head of the ENT department at the LUMC. How do the two roles relate to each other?
‘At the Federation we’ve got a health-care evaluation programme to look at what’s going well and what could be done better. If you improve your health service, it may also become cheaper. That’s also true for my discipline. A study published in 2004 concluded that it might be better not to remove children’s tonsils straight away but to wait a while instead. The research findings were incorporated in the ENT association’s guidelines. By 2012 you could see that this kind of operation had decreased by 40%. That shows how powerful this kind of health-service evaluation can be. I’m currently also supervising a PhD candidate at the LUMC who is looking into the impact of the tonsil guidelines. She is researching the precise effect of us performing fewer tonsillectomies, in terms of both public health and savings. The effect appears to be huge. In short, what I’m dealing with at the “macro level”, ends up at “the micro level”, in the research at my own hospital. And the results of this research also help me with the policy side of things.’
What if you had to choose one of the two roles?
He laughs. ‘I really don’t know. I’ve always enjoyed the mix. I joined the board of my old hospital in Apeldoorn because there were things I thought could be done better. And I found it interesting to deal with the administrative side. On the shop floor you learn all sorts of information from everyday practice that you can then do something with at an administrative level. The value is in the mix. There’s no way I could decide to stop being a doctor. It’s too great a job for that, and I’d also lose my value for the Federation.’
‘The value is in the mix. There’s no way I could decide to stop being a doctor. It’s too great a job for that, and I’d also lose my value for the Federation.’
When coronavirus is behind us, what improvements to the health service will the Federation focus on then?
‘I’d like to see the discussions between hospitals and health insurers in the coming years being less about production agreements – how many patients you treat – and more about the content. Let’s sign long-term contracts so there is security for the institutions and doctors. Then you can talk much more about how to improve the quality of your health services. I also think a good IT infrastructure is really important. We should have access to patient data from other institutions. Many of my patients are referred to us from other hospitals but I can’t see their patient files from those hospitals. That’s tied up with the public debate about privacy. But I’ve never had a patient say to me: “Thanks for protecting my privacy Dr van Benthem and not knowing what’s happened to me at another hospital.” Most patients have the following to say about their patient history: “It’s all on the computer, isn’t it?” I also think good IT support for e-health is really important for remote care.’
‘I’ve never had a patient say to me: “Thanks for protecting my privacy Dr van Benthem and not knowing what’s happened to me at another hospital.”’
How does the Federation think we should tackle the treatment that has been postponed because of Covid?
‘We’ll need unorthodox solutions. We’re in survival mode at the moment, with more patients in intensive care now than during the first wave. I had 14 nurses at home ill from my own department. Three doctors fell ill and seven had to quarantine. Our ENT department didn’t even have enough time to catch up with the postponed treatment during the two waves. I hope we’ll get around to it again soon. Then there’ll be a huge group of people who need an operation, so that they can hear again, for instance, something they’ve been unable to do for, in some cases, an additional one or two years. A huge investment will be needed at any rate in terms of staff to care for the patients who are waiting for an operation.’
With all the treatment that has been postponed, will hospitals have time to sit down with health insurers and discuss long-term contracts and quality improvements?
‘The pressure may actually give us some insight into what we have to tackle first to improve the quality. What causes the greatest reduction of quality?’
One last question: what do you like best about your work, as a chair and as a doctor?
‘As a chair I really like seeing the great power and drive of the medical profession. I’m hugely proud of it. As head of an academic department what I enjoy most is to inspire and be inspired by young people.’
Aren’t you itching to get stuck in again when you see those youngsters?
‘I always tell them how envious I am that they get to do this.’
Text: Jan Joost Aten
Federation of Medical Specialists
The Federation of Medical Specialists brings together all 33 specialisms in the Netherlands. Medical specialists are a member of one of the 33 academic associations that together form the Federation, which has 23,000 members in total. The Federation helps its members develop their skills, by carrying out quality and training assessments, for example. It also joins in the political and societal debates on the health system, and offers individual services to its members through a national knowledge and service centre.
Peter Paul van Benthem: CV
1987-1992
Medical degree in Rotterdam, specialising in Otorhinolaryngology at the predecessor of University Medical Center Utrecht.
1992
PhD: Histophysiological research on an animal model for Meniere’s disease.
1993
Joins ENT department at a hospital in Apeldoorn, works part-time at ENT department at the University Medical Centre Utrecht. Conducts clinical research into Meniere’s disease.
1993 - 2015
Chair of ENT staff Gelre Hospital Apeldoorn
2015 - heden
Professor and head of department of Eyes, Nose and Throat department, LUMC
2016
Board of the Dutch ENT association, chair of the first research agenda for the ENT science committee .
2016
Board of Federation of Medical Specialist, science and innovation portfolio
2020
Chair of Federation of Medical Specialists